The aim of the study is to update the evidence on surgical management of endometriosis associated pain - does laparoscopic excision offers any benefits over laparoscopic ablation? This is a systematic review and meta-analysis, where we searched MEDLINE, EMBASE, ISI conference proceedings, ISRCTN, Register and Meta-register for RCTs, WHO trials search portal, Cochrane Library and the 'British Library of electronic theses'. Three RCTs were included which enrolled 335 participants with a sample size per study ranging from 24 to 178 participants. Out of these three studies, data from two could be pooled for meta-analysis. Primary outcome measure was reduction in VAS score for dysmenorrhea. Secondary outcome measures included reduction in VAS score for dyspareunia, dyschezia, chronic pelvic pain and reduction in EHP30 Core pain scores. Meta-analysis showed that the excision group had a significantly greater reduction in symptoms of dysmenorrhea (MD 0.99; 95% CI -0.02, 2.00; p = 0.05), and dyschezia (MD 1.31; 95% CI 0.33, 2.29; p = 0.009) compared with ablation. The symptoms of dyspareunia showed non-significant benefit with excision (MD 0.96; 95% CI -0.07, 1.99; p = 0.07). Data from one study showed a significant reduction in chronic pelvic pain (MD 2.57; 95% CI 1.27, 3.87; p = 0.0001) and EHP30 Core pain scores (MD 13.20; 95% CI 3.70, 22.70; p = 0.006) with the excision group as compared with the ablation group. The limited available evidence shows that at twelve months post-surgery, symptoms of dysmenorrhea, dyschezia and chronic pelvic pain secondary to endometriosis showed significantly greater improvement with laparoscopic excision compared with ablation.