AN EVALUATION OF PRESACRAL NEURECTOMY IN THE TREATMENT OF DYSMENORRHEA

Abstract The results of 255 cases of presacral neurectomy for dysmenorrhea of both the essential and the acquired types are reviewed. A comparative study is made between the 136 cases performed from 1931 to 1940, and the 119 cases from 1941 to 1945. Complete relief from what is commonly termed essential dysmenorrhea (cramps) was obtained in 78 per cent of cases. There was some degree of improvement of symptoms in a further 11 per cent. Complete relief from acquired dysmenorrhea occurred in only 33.3 per cent of cases. Total failure of the procedure was recorded in 11 per cent of the essential dysmenorrhea group, whereas this poor result obtained in 41.7 per cent of the acquired dysmenorrhea group. The offending pathologic conditions in the acquired cases are reviewed. It is pointed out that pelvic inflammation and endometriosis made up about 60 per cent of this group; 21 per cent of cases in these two categories came to total hysterectomy nine months to four years after presacral neurectomy was performed. We wish to emphasize that presacral neurectomy is still a court of last resort in the treatment of dysmenorrhea, that the operation carries with it the risks of laparotomy, and that good medical management should be attempted in each individual case before resorting to surgery unless other indications for laparotomy exist.