Laparoscopy in the Management of Women with Chronic Pelvic Pain

Suleiman A. Al‐Suleiman
In: Australian and New Zealand Journal of Obstetrics and Gynaecology · 1991 · vol. 31(1) , pp. 63–65 · doi:10.1111/j.1479-828x.1991.tb02768.x · PMID:1831347 · W1977848581
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This study evaluated 232 women with chronic pelvic pain, finding a poor correlation between preoperative pelvic exams and laparoscopy findings, with laparoscopy identifying significant pelvic pathology in many patients.

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Abstract

EDITORIAL COMMENT: We accepted this paper for publication because it analyses the fallibility of bimanual pelvic examinations in assessment of pelvic pathology, in comparison with laparoscopy, in a large series of women with chronic pelvic pain. Although 85% of patients had ultrasonography, the value of this investigation was not presented. We were surprised to read that only 9 of the 246 women had laparoscopic evidence of endometriosis. Although all patients had preoperative bacteriological study, the authors do not discuss the findings, nor indicate if chlamydial infection was sought for by culture or immunofluorescence testing. It would seem wise to perform bacteriological cultures (including testing for Chlamydia trachomatosis)from the pelvic peritoneum and any identified focus of infection in all women with chronic pelvic pain who have laparoscopy performed. Summary: review of 232 women who had diagnostic laparoscopy for chronic pelvic pain was undertaken. Diagnostic error in the preoperative pelvic examination in the series varied from 21% to 61%; of 135 patients who had normal pelvic examination findings preoperatively, 82 (61%) were found to have pelvic pathology on diagnostic laparoscopy, whereas 21 of 97 women (21.6%) who had abnormal pelvic examination, had normal findings on laparoscopy. The overall incidence of pelvic pathology in the series was found to be 69%. Our results suggest that there is poor correlation between findings of pelvic examination and the existence of pelvic disease. Laparoscopy has a definite place in the evaluation of patients with chronic pelvic pain and certainly justifies its increasing use in their management.

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endometriosischronic_pelvic_pain

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