Laparoscopy in the Chronic Pelvic Pain Patient: Incidence and Outcomes of Subsequent Laparoscopies [20H]

INTRODUCTION: Our aim is to determine the incidence of multiple laparoscopies for chronic pelvic pain over 10 years and to compare outcomes between patients who underwent single vs multiple laparoscopies. METHODS: An IRB approved retrospective case-control study of women at a tertiary medical center with a diagnosis of chronic pelvic pain that underwent one laparoscopy in comparison with those who underwent multiple laparoscopies in a 10-year period. Parametric, nonparametric and descriptive statistics were employed. RESULTS: 678 controls with single laparoscopy and 114 cases with multiple laparoscopies were identified. 400 (59%) had medical management prior to initial laparoscopy in the control group and 82 (72%) in the cases. 559 had diagnostic and 119 had extirpative laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 extirpative laparoscopies in the multiple laparoscopy group. Of the patients with persistent pain after initial laparoscopy, 56 underwent hysterectomy with 22 having pain resolution, 5 persistent, 4 improved and 15 unknown. The average number of subsequent laparoscopies in the multiple laparoscopy group was 2.27. 38 patients underwent hysterectomy with 18 having pain resolution, 4 persistent, 6 improved and 12 unknown. 25 patients were identified as having pathologic evidence of endometriosis in the single laparoscopy group vs 32 in the multiple laparoscopy group. CONCLUSION: This study reviews the outcomes of chronic pelvic pain in relation to laparoscopic management. It suggests that majority of patients undergo nonsurgical management prior to initial laparoscopy and that patients in the multiple laparoscopy group have a greater likelihood of undergoing subsequent hysterectomy with pain resolution.