LAPAROSCOPIC TREATMENT OF CHRONIC PELVIC PAIN IN 100 ADULT WOMEN

Study Objective. To evaluate the effectiveness of laparoscopic surgica l treatment for women with chronic pelvic pain. Design. Prospective ev aluation of women treated consecutively between January 1, 1989, and D ecember 31, 1999. Setting. A private practice. Patients. One hundred w omen with chronic pelvic pain. Interventions. Laparoscopic treatment w as performed in all patients. Pain level was rated on a scale of 7 to 70 (1 = no pain, 10 = severe, disabling pain). Patients recorded their pain levels before and 1 month, 3 months, and 6 months after surgery, as well as at intervals of 1, 2, and 3 years after surgery. Measureme nts and Main Results. Preoperatively, the average pain level reported by the patients was 8.2. At 7 month after laparoscopic surgical therap y, it had dropped to 3.6, at 6 months to 1.9, and at 3 years to 2.2. T wenty patients reported pain levels of 5 or greater at the 6-month int erval. Six of them proceeded to hysterectomy, and four of these six we re found to have adenomyosis. Eleven of the 100 who had pain levels gr eater than 5 after the initial procedure had no further therapy, and 3 underwent repeat laparoscopy. Conclusion. Extensive laparoscopic surg ery to restore normal pelvic anatomy and remove all diseased tissue, i ncluding treatment of all endometriosis, resection of ovarian cysts, r esection of adhesions, removal of the appendix, and treatment of herni as when indicated, together with laparoscopic uterosacral nerve vapori zation or presacral neurectomy, results in significant improvement in reported pain levels.