LONG-TERM OUTCOME OF LAPAROSCOPIC PRESACRAL NEURECTOMY FOR THE TREATMENT OF CENTRAL PELVIC PAIN ATTRIBUTED TO ENDOMETRIOSIS

Objective: To evaluate the long-term pain reduction achieved by laparo scopic presacral neurectomy. Methods: One hundred seventy-six women wi th median (range) age 30 (18-45) years underwent presacral neurectomy combined with excision and vaporization of endometriotic lesions and w ere observed, using structured questionnaires, for up to 72 months pos toperatively. The study included a convenience sample of the first 100 questionnaires returned. Forty of the women were studied for 12-23 mo nths, and 60 for 24-72 months. The main outcome measures were reductio n of pelvic pain, dysmenorrhea, and dyspareunia after surgery. Results : Pelvic pain, dysmenorrhea, and dyspareunia were reportedly reduced b y more than 50% in 74, 61, and 55 patients, respectively, more than 12 months after laparoscopic presacral neurectomy. More than 50% reducti on in pelvic pain was reported by 69.8%, 77.3%, 71.4%, and 84.6% of th e patients, respectively, with endometriosis stages I-IV, using the re vised classification of the American Fertility Society. Comparatively, more than 50% reduction in dysmenorrhea was reported by 52.8% of the patients with stage I endometriosis, 68.2% with stage II, 71.4% with s tage III, and 69.2% with stage IV. Reduction of dyspareunia by more th an 50% was reported by 54.7% of the patients with stage I endometriosi s, 50.0% with stage II, 28.6% with stage III, and 61.5% with stage IV. Conclusion: Long-term outcome of laparoscopic presacral neurectomy is satisfactory in the majority of patients. The stage of endometriosis is not related directly to the degree of pain improvement achieved. (C ) 1998 by The American College of Obstetricians and Gynecologists.