An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for chronic pelvic pain
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Abstract
We evaluated the outcome of microsurgical (n = 72) and laparoscopic (n = 51) adhesiolysis in women who complained of chronic pelvic pain. Adhesion severity was not significantly different between the two treatment groups. The influences of the following variables on the outcome of all 123 cases of adhesiolysis were examined: (i) surgical modality (microsurgical or laparoscopic), (ii) history of infertility, (iii) associated dyspareunia and (iv) aetiological factors of adhesive disease (endometriosis, pelvic inflammatory disease and previous laparotomy). To adjust for differences in follow-up intervals, overall and subgroup cumulative rates of pain persistence/recurrence were calculated and compared. To adjust for interrelationships between variables and to correct fo differences between the treatment groups, a proportional hazards regression analysis was employed. This analysis showed that the cumulative rate of pain persistance/recurrence at 24 months was not significantly different after microsurgical (44%) and laparoscopic (53%) adhesiolysis. From all the variables which were examined, the only one which appeared to influence the impact of surgical adhesiolysis for chronic pelvic pain was a history of previous laparotomy. A history of previous laparotomy was associated with approximately three times higher rates of pain persistence or recurrence. This effect did not depend on whether previous laparotomy was carried out for pain or for other indications. The most likely explanation for the failure of these patients who had a previous laparotomy to respond to surgery is that they intrinsically have a higher rate of adhesion formation and reformation. This can only be confirmed with a prospective study where all patients will undergo a second-look laparoscopy.
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Cited by (22)
- Dolor pélvico crónico de la mujer. Orientación diagnóstica y conducta práctica 2018
- Role of Laparoscopy in Infertility : Review Article 2012
- Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness 2012
- Chronic Pelvic Pain and Adhesions 2011
- Pelvic and Perineal Pain in Women 2010
- Role of laparohysteroscopy in women with normal pelvic imaging and failed ovulation stimulation with intrauterine insemination 2010
- Chronic pelvic pain 2008
- Laparoscopy should be strongly considered for women with unexplained infertility 2007
- Algies pelviennes chroniques de la femme. Orientation diagnostique et conduite à tenir 2006
- Algias pélvicas crónicas de la mujer. Orientación diagnóstica y conducta que se debe seguir 2006
- Douleurs pelviennes 2006
- Surgical management of endometriosis 2004
- Douleurs pelviennes 2004
- Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination 2003
- The changing nature of elective laparoscopic surgery: A review over a 7 year period in a reproductive surgery unit 2001
- 10.1016/s0246-1064(19)30028-3 2000
- Surgical management of endometriosis 2000
- 10.1016/s0000-0000(07)45716-3 2000
- 10.1016/s1241-8234(05)23095-x 2000
- 10.1016/s0246-1064(17)65085-0 2000
- Chronic pelvic pain 1998
- Chronic pelvic pain (CPP) - gynaecologic and psychosocial factors 1998
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