LAPAROSCOPIC TREATMENT OF CHRONIC PELVIC PAIN

Presacral neurectomy is useful in the treatment of severe, disabling dysmenorrhea secondary to endometriosis and pelvic pain associated with pelvic inflammatory disease. The efficacy of presacral neurectomy for the relief of midline dysmenorrhea was confirmed by a randomized study performed at the Johns Hopkins University School of Medicine. Tjaden used the surgical technique first described in 1899 by Jaboulay and Ruggi. Black estimated a 75% to 80% success in 9937 cases of presacral neurectomy. Laparoscopic techniques for presacral neurectomy have been described by Perez, Biggerstaff, Carter, Chen, and Nezhat. Kwok reviewed laparoscopic presacral neurectomy and concluded that patients for whom this operation is recommended should be carefully selected. They should have midline dysmenorrhea as the main symptom and should have failed or not tolerated medical therapy. Presacral neurectomy has been shown to have long-run effectiveness for the treatment of severe dysmenorrhea due to endometriosis. As has been pointed out by Stones and Jacobson, a percentage of women with chronic pelvic pain and/or dysmenorrhea do not respond or respond poorly to medical treatment. Surgery may represent the final therapeutic option for these patients. In a prospective double-blind randomized, controlled study, Zullo et al. demonstrated the effectiveness of presacral neurectomy for women with severe dysmenorrhea due to endometriosis who had been treated with conservative laparoscopic surgical intervention.