Study Objective To evaluate local patterns of surgical diagnosis and treatment of endometriosis and to determine whether excision versus ablation altered the need for repeat surgery within 2 years in a community hospital setting. Design Retrospective cohort analysis. Setting Community teaching hospital. Patients or Participants All patients who underwent conservative surgery between 1/2013-12/2016 for endometriosis, excluding hysterectomy and unilateral or bilateral oophorectomy. 294 patients met inclusion criteria. Interventions Laparoscopic excision or ablation of endometriosis. Measurements and Main Results 74(25.2%) of the patients had a repeat surgery within two years, 22 (20.6%) after excision and 52 (27.8%) after ablation (RR 0.74, 95% CI 0.48-1.15). Endometriosis was diagnosed by tissue biopsy in 151(51.4%) and by visual inspection alone in 143(48.6%). 107(36.4%) underwent endometriosis excision; 80(27.2%) underwent excision alone while 27(9.2%) had both excision and ablation. 187(63.6%) underwent endometriosis ablation; 140(47.7%) had radiofrequency (RF) ablation only, 44 (14.9%) had RF ablation with biopsy and 3 (1.0%) had laser ablation. The 2 year reoperation risk was lower with robotic (6%) vs traditional laparoscopic excision (28%) but did not achieve statistical significance (RR 0.28 95% CI 0.07 to 1.16). Conclusion There was no difference in the risk of repeat surgery within 2 years whether endometriosis was excised or ablated. Excision using robot-assisted technique showed a non-significant trend toward a decrease in reoperation rate. In this clinical center, endometriosis ablation and excision are equally effective to prevent repeat surgery. The method should be selected based on surgeon experience.