Laparoscopy in chronic pelvic pain

Objectives : Chronic pelvic pain (CPP) is best defined as the non menstrual pelvic pain for at least six months, which is severe enough to cause functional disability and require medical or surgical treatment. A thorough clinical examination no doubt provides a gynecologist with considerable information but that is not sufficient in arriving at the diagnosis or pinpointing the cause of CPP in all cases. Ancillary aids like imaging studies and direct visualization of the pelvic organs by laparoscopy are often required. In this study we made an endeavor to find out the role of laparoscopy in the evaluation of CPP. Methods : The present study was conducted in the department of Obstetrics and Gynecology, Medical College and Hospital, Kolkata from January 2006 to December 2006. All the patients presented with the complaint of CPP. After history, physical examination, routine investigations and USG, 79 cases were subjected to laparoscopy. Results: Sensitivity and specificity of USG was found to be 69.56% and 100% respectively while for laparoscopy it was 98.46% and 100% respectively. Positive predictive value was 100% by both means but negative predictive value was significantly higher by laparoscopy i.e. 93.75% in marked contrast to USG (34.8%). Conclusion: Laparoscopy triumphs in detecting many abnormalities which clinical methods and USG sometimes fail to identify. This enforces the position of laparoscopy as a gold standard in the evaluation of CPP.