PEARS (Pelvic Excision And Repair Surgery)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 11, 2026

PEARS (Pelvic Excision And Repair Surgery) is a form of plastic reconstructive surgery of the pelvis developed by Dr. Thomas Hilgers at the Pope Paul VI Institute.¹ The name reflects the procedure's dual mandate: complete excision of pelvic disease and systematic anatomic repair.

In PEARS, endometriosis is excised rather than ablated. This is not a technical preference. Ablation destroys the surface of a lesion; excision removes it entirely, including the base. Disease masked by destruction continues to progress. Disease removed is gone.²

Excision is only half the procedure. The repair component applies a layered system of anti-adhesion measures: micro-monopolar or CO₂-laser technique, Prolene imbricating closure of the peritoneum and ovarian cortex with rough edges inverted internally, heparinized Ringer's lactate irrigation, and talc-free hydro-pack bowel isolation. The imbricating closure leaves only smooth, glistening serosa exposed to the peritoneal cavity. This matters because post-operative adhesions are a leading cause of secondary infertility after pelvic surgery.

PEARS applies across the full range of pelvic pathology: peritoneal endometriosis, ovarian endometriomas, polycystic ovaries, fibroids, fallopian tube disease, and adhesive disease.¹ The goal is not symptom relief. The goal is anatomic restoration of fertility.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.