Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study

Géraldine Brichant, Marie Denef, Linda Tebache, Gaëlle Poismans, Serena Pinzauti, Valérie Dechenne, Michelle Nisolle
In: Gynecological Surgery · 2018 · vol. 15(1) · doi:10.1186/s10397-018-1045-5 · W2884339549
article OA: hybrid CC0 ⤵ 8 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

Exploratory laparoscopy identified pelvic anomalies in 98% of patients with chronic pelvic pain and normal initial exams, leading to significant pain improvement in 59% post-surgery.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

This retrospective observational study (2011–2015) included 48 reproductive-age women with chronic pelvic pain (CPP) of high intensity (VAS ≥ 8) and negative clinical examination and imaging, at a tertiary endometriosis referral center; exploratory laparoscopy was used to identify pelvic lesions and deliver procedure-specific surgical treatment. In 98% of cases, laparoscopy detected pelvic anomalies not previously identified, most commonly endometriotic lesions or suspected endometriosis via uterosacral ligament (USL) thickening, adhesions, uterine anomalies (with adenomyosis suspicion), and adnexal anomalies, with histology confirming related pathology in some macroscopic/suspected categories (a stated limitation is that confirmation was not complete across all lesion types). Postoperatively, 59% of evaluable patients reported significant CPP improvement (VAS < 5) at follow-up, with pain categories remaining severe (VAS ≥ 8) in 22%. This paper is centrally about endometriosis — it reports that exploratory laparoscopy frequently uncovers endometriotic and USL-related lesions and assesses postoperative CPP improvement after surgical management in an endometriosis referral population.

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Abstract

Abstract Background Forty percent of exploratory laparoscopies are performed for chronic pelvic pain (CPP). However, a final diagnosis is still unreported in 35% of the patients. We decided to evaluate the identification of pathological lesions and the improvement of painful symptoms in patients with CPP and normal physical examination and imaging and who are scheduled for exploratory laparoscopy. The prospective study was designed in a tertiary referral center for endometriosis. Forty-eight patients complaining of CPP and scheduled for exploratory laparoscopy were included. Pelvic pain intensity was assessed using the visual analogue pain scale (VAS), and at inclusion, negative clinical and imaging assessments were required. During exploratory laparoscopy, the recognized lesions were reported and different surgical treatment options were performed depending on the location of the lesion. Results In 98% of the cases, exploratory laparoscopy demonstrated the presence of pelvic anomalies that had not been diagnosed at the time of clinical and imaging examination. After surgery, a significant improvement of CPP has been demonstrated in 24 (59%) patients with VAS < 5 postoperatively. Conclusions Exploratory laparoscopy is reasonable in patients complaining of CPP, allowing a final diagnosis in a high percentage of patients and a significant improvement in pain symptom in 59% of the cases. This study was retrospectively registered by our local Ethics Committee on February 7, 2018 (B412201835729).

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Outcome instruments

VAS-pain

Condition tags

endometriosischronic_pelvic_pain

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