Review
of effectiveness of LUNA and PSN in endometriosis surgery
Systematic review
of laparoscopic uterosacral nerve ablation (LUNA) and
presacral neurectomy (PSN) shows the evidence for nerve
interruption in the management of dysmenorrhea is limited
A review lead by Latthe et al at the
University of Birmingham, UK, aimed to compare the two
main surgical procedures available designed to cut sensory
nerves in patients with dysmenorrhea. The two procedures
that were evaluated and compared were ablation (removal)
of the uterosacral nerve and removal of the presacral
nerve.
Of the nine trials analysed in this
study, two involved open presacral neurectomy while
the others involved laparoscopic techniques. The two
key details gathered in all the studies were the effectiveness
of the operation on pain relief and the mildness or
absence of side effects. The results are different for
surgeries between primary and secondary dysmenorrhea.
Primary dysmenorrhea is menstrual pain presented by
women who are otherwise healthy. Secondary dysmenorrhea
is pain associated with an underlying medical condition,
such as in endometriosis.
All of the results were collected at
twelve months after the surgery. Primary dysmenorrhea
patients responded to surgery better than either no
treatment or a control treatment; however responding
better to presacral ablation than to laparoscopic uterosacral
nerve ablation (LUNA). In secondary dysmenorrhea with
inclusion of patients with endometriosis, it was found
that LUNA did not provide further pain relief when combined
with laparoscopic treatment of endometriosis. Patients
did however respond better to laparoscopic treatment
of endometriosis when combined with presacral ablation
than to just laparoscopic treatment alone. Complications
were more common in patients who underwent presacral
ablation than surgeries that did not involve presacral
ablation.
Dr Latthe concludes that the evidence
for nerve interruption in the management of dysmenorrhea
is limited and that methodologically sound and sufficiently
powered randomized controlled trials are required in
determining its efficacy in pain management in dysmenorrhea.
Review by: Eddie
Ma
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