A simplified method of laparoscopic presacral neurectomy for the treatment of central pelvic pain due to endometriosis

OBJECTIVE: To describe optimal procedures and preliminary results for videolaparoscopic presacral neurectomy as part of the surgical treatment of endometriosis associated with intractable dysmenorrhoea. DESIGN: Observational study with follow up for at least one year. SETTING: Subspecialty practice: Endometriosis Clinic and Centre for Special Pelvic Surgery. SUBJECTS: Eighty five women (18-45 years) with endometriosis and intractable pain, referred because medical and surgical management had failed. Subjects without a central (midline) component to their discomfort were excluded. INTERVENTIONS: Excision and vaporization of endometriotic pathology was followed by presacral neurectomy. OUTCOME MEASURES: During surgery, severity of endometriosis was assessed using revised American Fertility Society scoring. Overall pelvic pain and dysmenorrhoea relief were determined by office visit, telephone interview and questionnaire at a minimum of one year postoperatively. RESULTS: There were no operative complications and all women left hospital within 24 h of surgery. Overall pain relief was reported by 49 (94%) of 52 patients followed. The other three subjects noted no pain abatement. Dysmenorrhoea was reduced in 48 (92%) whereas four (8%) women claimed no relief. CONCLUSIONS: Laparoscopic presacral neurectomy is an option for treating dysmenorrhoea and pelvic pain in selected women, but is indicated only if medical management has failed. Videolaparoscopic presacral neurectomy using the CO2 laser is safe in trained hands. Pain relief achieved is within the range reported for laparotomy.