THE ROLE OF UTEROSACRAL LIGAMENT RESECTION IN CONSERVATIVE OPERATIONSFOR RECURRENT ENDOMETRIOSIS

Fifteen patients with a history of endometriosis and recurrent pelvic pain underwent conservative resection at laparotomy. Microsurgical res ection of endometriotic lesions and restoration of pelvic anatomy were performed. Presacral neurectomy was carried out in 12 of 15 (80%) pat ients complaining of significant midline pelvic dysmenorrhea. All pati ents had retroperitoneal dissections and bilateral uterosacral ligamen t resections regardless of whether or not there was clinical suspicion of uterosacral ligament involvement. Dysmenorrhea, dyspareunia, and d yschezia were relieved in 12 of 15 (80%), 7 of 12 (58%), and 8 of 11 ( 77%) patients, respectively. Eight patients (54%) had histological inv olvement of the uterosacral ligaments. Of this subgroup of patients, a ll had relief of dysmenorrhea, dyspareunia, and dyschezia postoperativ ely. Gross appearance was not always reliable in determining uterosacr al ligament involvement. We believe that bilateral uterosacral ligamen t resection may benefit patients with endometriosis by improving sympt oms of deeply infiltrating lesions (dyspareunia, dyschezia) in additio n to the known effects of conservative resection and presacral neurect omy in alleviating dysmenorrhea. Further study of this adjunctive proc edure in a prospective fashion appears warranted.