[Laparoscopy in chronic pelvic pain--a retrospective clinical study].

OBJECTIVES: To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). To verify the possible predictive value of the anamnestic factors for the laparoscopically established diagnosis. DESIGN: A retrospective clinical trial. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in the last 5 years. With the help of statistical analysis (chi 2) the possible influence of age, previous surgical intervention, history of PID, dysmenorrhea, infertility, and some other factors on endoscopic finding was verified. RESULTS: 480 laparoscopies for CPP were performed from the year 1995 to 1999. The most frequent findings were adhesions (22.3%), endometriosis (20.4%), PID (17.7%), and normal finding (17.7%). In 53% of all cases the operative laparoscopic procedure was done, most frequently the adhesiolysis (62.2%). Only one serious complication during laparoscopy was recorded (0.21%). In women younger than 30 years endometriosis was the most frequent finding (22.8%), in women older than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between the groups was statistically significant (P < 0.0001). In patients with previous operation in pelvis the adhesions were found most frequently (46.2%). Diversity of findings in women with and without previous operation was also significant (P < 0.0001). In women treated for PID, pelvic inflammation was found in 25.8%, but in 22.5% the finding was negative and in 20.2% the endometriosis was diagnosed. In these subgroups (women after and without treatment of PID) the diversity of findings was not significant (P < 0.1). In infertile women, suffering from CPP, PID was found most frequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients with dysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominant finding (30.4%, resp. 29.1%). CONCLUSION: Laparoscopy for CPP is a safe and effective method for verifying and adequate therapy of as yet hidden pathological findings. With the help of anamnestic factors some laparoscopic findings are predictable; although the sensitivity and specificity is very poor.