EFFICACY OF LAPAROSCOPIC PELVIC DENERVATION IN CENTRAL-TYPE CHRONIC PELVIC PAIN - A MULTICENTER STUDY

Our aim was to evaluate the efficacy of laparoscopic pelvic denervatio n (uterosacral resection or presacral neurectomy) for the treatment of chronic pelvic pain with a predominant central-type localization in w omen with endometriosis or with no visible pathology. In a retrospecti ve analysis performed in six centers, we evaluated the data relative t o 58 patients with midline pelvic pain laparoscopically treated, with a follow-up of at least 6 months including a quantitative pain assessm ent. The distribution of types of pain (dysmenorrhea, deep dyspareunia , and pelvic pain not related to menses or coitus) was not different a mong stage I-II endometriosis, stage III-IV endometriosis, and no visi ble pathology, except that deep dyspareunia was significantly (p < 0.0 5) less frequent in the absence of visible pathology than in moderate to severe endometriosis. Both types of laparoscopic denervations signi ficantly (p < 0.001) reduced after 6 months the intensity of midline d ysmenorrhea, pelvic pain, and deep dyspareunia in both endometriosis p atients who also had undergone conservative surgery and women without any laparoscopically visible pathology. Presacral neurectomy was signi ficantly more effective than uterosacral resection in the relief of dy smenorrhea. No major adverse effects were reported; and minor side eff ects were comparable between the two techniques. In conclusion, both p resacral neurectomy and laparoscopic uterosacral resection are highly effective in reducing midline pelvic pain performed either alone or in combination with the classic ablative surgery for endometriosis.