Can endometriosis be missed during surgery?

Yes—endometriosis can be missed during surgery, especially when lesions are subtle, atypical in color, or hidden under normal-looking peritoneum. Some disease sits in small peritoneal pockets or “windows,” can be mistaken for scar tissue or inflammation, or may be located outside the areas a routine pelvic laparoscopy focuses on.

Whether it’s found depends heavily on the surgeon’s endometriosis-specific training, the quality of visualization, and how thoroughly the pelvis and (when indicated) upper abdomen are evaluated. Technique matters too: simply burning what’s visible can leave deeper disease behind, while targeted excision aims to remove endometriosis at its roots and confirm it on pathology.

If you’ve had “negative” or incomplete surgery but your symptoms persist, it doesn’t automatically mean you don’t have endometriosis—it may mean it wasn’t identified, sampled, or fully addressed. Our team takes a whole-person diagnostic approach before and after surgery so we don’t stop at what’s easiest to see, and we also look for common coexisting conditions that can mimic or amplify endometriosis pain. If you’d like, reach out to schedule a consultation so we can review your history, imaging, and prior operative findings and map a clearer plan forward.