Significance
of laparoscopy in the management of chronic pelvic pain
Restrospective data analysis
shows that laparoscopy is essential in the diagnosis
and management of chronic pelvic pain
Between 1 January 1979 and 31 December 2002 the authors
had performed 11,681 laparoscopic interventions. Among
them, 1061 operations (9.08%) were done because of chronic
pelvic pain.
In 29.5% of these cases no anatomical abnormality was
found. Analysis of data of laparoscopic operations performed
from 1989 to 1990 and from 1998 to 1999 revealed that
complaints dated back for a significantly longer period
of time in patients presenting no obvious sign of pelvic
anatomical anomaly when compared with those who had
positive findings.
In patients with positive pelvic findings laparotomy
had previously been performed in a significantly higher
number. When no apparent pelvic pathology was found
medical history was also negative for ectopic pregnancy.
Similarly, there were only three cases of previous adnexal
operations.
However, among patients with positive findings, medical
history revealed 19 prior cases of ectopic pregnancy,
49 cases of previous adnexal operations, 82 appendectomy,
and 26 cholecystectomy (p<0.01). Among patients with
positive pelvic findings, diagnostic laparoscopy was
immediately completed by adequate surgical treatment
in the same session in more than two-third of cases.
Most frequently this included adhesiolysis, ovarian
cystectomy, uterosacral nerve ablation, electrocoagulation
of areas of endometriosis, and ventrosuspension of the
retroflected uterus.
Based on their retrospective data analysis the authors
believe that laparoscopy is an essential method for
the diagnosis and management of chronic pelvic pain.
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