Experience of pelvic peritonectomy in patients with persistent pelvic pain

Tetsuji Odagiri, Maki Kanno, Kenrokuro Mitsube, Hidenori Kato, Masanori Kaneuchi, Takashi Fujino, Akira Suzuki, Masataka Kudo, Eiji Nomura
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2008 · vol. 24(1) , pp. 218–223 · doi:10.5180/jsgoe.24.218 · W2327554944
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

Laparoscopic peritonectomy combined with uterosacral nerve ablation provided pain relief for patients with refractory pelvic pain, including those without a preoperative endometriosis diagnosis, and was found to be safe.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This study assessed laparoscopic resection of the pelvic peritoneum added to conventional laparoscopic uterosacral nerve ablation (LUNA) for treatment-refractory persistent pelvic pain in 13 patients without a preoperative diagnosis of endometriosis. Intraoperative findings were re-reviewed from surgical videos, and peritoneal specimens were pathologically examined, with postoperative dysmenorrhea, chronic pelvic pain, dyspareunia, and dyschezia evaluated by interview-based questionnaires over 12 months. Although 5/13 were diagnosed as endometriosis postoperatively, in the remaining 8 cases without endometriosis the authors reported peritoneal adhesions, suspected infection, or no abnormal findings, and pathology showed scar/fibrosis or localized inflammatory cell accumulation in subsets. The authors concluded the combined procedure seemed safe and effective, while the main limitation is the small, single-arm sample size without a control group, and some patients required postoperative NSAIDs and/or oral contraceptives. Relevance to endometriosis: endometriosis was identified in 5 of the 13 participants after surgery and contributed to the reported postoperative diagnostic and pathological findings, though the paper’s main focus is evaluating pelvic peritonectomy plus LUNA for persistent pelvic pain in patients without a preoperative endometriosis diagnosis.

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Abstract

OBJECTIVE: The aim of this study was to assess the efficacy of laparoscopic resection of pelvic peritoneum in addition to conventional laparoscopic uterosacral nerve ablation (LUNA) procedure on the relief of treatment refractory pelvic pain in patients without preoperative diagnosis of endometriosis.METHODS: We performed laparoscopic peritonectomy combined with LUNA in 13 patients who had not been diagnosed as endometriosis. Intraoperative findings were re-assessed by videos recorded during surgery. Peritoneal specimens were pathologically reviewed. Postoperative details on dysmenorrhoea, chronic pelvic pain (CPP), dyspareunia and dyschezia were evaluated using an interview-based questionnaire.RESULTS: Five out of all 13 cases were diagnosed as endometriosis post operatively. In 8 cases without endometriosis, 4 had peritoneal adhesion, 3 had suspicion of infection and 3 without any abnormal findings. The pathological observations showed scar and fibrosis of peritoneum in 4 cases, and neutrophil and eosinophil accumulation around the endothelium of vessels in 4 cases, suggesting localized inflammation. There was significant reduction in dysmenorrhea and CPP at 12 months follow up. The pain outcomes associated with intercourse or evacuation were reduced post operatively, either. There were no particular intra or postoperative complications observed. Three women needed post operative treatment with NSAIDs and/or oral contraceptives.CONCLUSION: Laparoscopic peritonectomy combined with LUNA seems safe and effective procedure to alleviate pelvic pain in patients without preoperative diagnosis of endometriosis.
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Abstract

OBJECTIVE: The aim of this study was to assess the efficacy of laparoscopic resection of pelvic peritoneum in addition to conventional laparoscopic uterosacral nerve ablation (LUNA) procedure on the relief of treatment refractory pelvic pain in patients without preoperative diagnosis of endometriosis.

Methods

We performed laparoscopic peritonectomy combined with LUNA in 13 patients who had not been diagnosed as endometriosis. Intraoperative findings were re-assessed by videos recorded during surgery. Peritoneal specimens were pathologically reviewed. Postoperative details on dysmenorrhoea, chronic pelvic pain (CPP), dyspareunia and dyschezia were evaluated using an interview-based questionnaire.

Results

Five out of all 13 cases were diagnosed as endometriosis post operatively. In 8 cases without endometriosis, 4 had peritoneal adhesion, 3 had suspicion of infection and 3 without any abnormal findings. The pathological observations showed scar and fibrosis of peritoneum in 4 cases, and neutrophil and eosinophil accumulation around the endothelium of vessels in 4 cases, suggesting localized inflammation. There was significant reduction in dysmenorrhea and CPP at 12 months follow up. The pain outcomes associated with intercourse or evacuation were reduced post operatively, either. There were no particular intra or postoperative complications observed. Three women needed post operative treatment with NSAIDs and/or oral contraceptives.

Conclusion

Laparoscopic peritonectomy combined with LUNA seems safe and effective procedure to alleviate pelvic pain in patients without preoperative diagnosis of endometriosis.

Methods

We performed laparoscopic peritonectomy combined with LUNA in 13 patients who had not been diagnosed as endometriosis. Intraoperative findings were re-assessed by videos recorded during surgery. Peritoneal specimens were pathologically reviewed. Postoperative details on dysmenorrhoea, chronic pelvic pain (CPP), dyspareunia and dyschezia were evaluated using an interview-based questionnaire.

Results

Five out of all 13 cases were diagnosed as endometriosis post operatively. In 8 cases without endometriosis, 4 had peritoneal adhesion, 3 had suspicion of infection and 3 without any abnormal findings. The pathological observations showed scar and fibrosis of peritoneum in 4 cases, and neutrophil and eosinophil accumulation around the endothelium of vessels in 4 cases, suggesting localized inflammation. There was significant reduction in dysmenorrhea and CPP at 12 months follow up. The pain outcomes associated with intercourse or evacuation were reduced post operatively, either. There were no particular intra or postoperative complications observed. Three women needed post operative treatment with NSAIDs and/or oral contraceptives.

Conclusion

Laparoscopic peritonectomy combined with LUNA seems safe and effective procedure to alleviate pelvic pain in patients without preoperative diagnosis of endometriosis. © JAPAN SOCIETY OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY AND MINIMALLY INVASIVE THERAPY Favorites & Alerts Recently viewed articles

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

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