RADICAL SURGERY FOR PELVIC PAIN

S276 Radical surgery for pelvic pain has been shown to be an effective form of therapy [1]. Patients subjected to hysterectomy may not be initially treated with conservative management. This study was undertaken to determine the number of patients who would fail to resolve their pain with conservative medical/surgical treatment. Methods: An SQL-92 relational database was utilized to ascertain patients seen in our hospital and clinics from 1990-June 1997 with the diagnosis of chronic pelvic pain. Surgical outcome for all patients was obtained. Patients treated with conservative medical therapy and laparoscopy were compared to those treated with laparoscopy and subsequent hysterectomy at a later date. Results: During a 7 year period from 1990 to 1997, 354 patients were evaluated and treated for chronic pelvic pain with laparoscopy and conservative medical therapy. Of these patients, 22 failed conservative treatment and subsequently underwent hysterectomy as a definitive therapy for pain. Average age was 34.4 years for the hysterectomy group and 29.2 years for the laparoscopy only group. (Figure 1)Figure 1Discussion: Diagnosis and treatment of chronic pelvic pain remains a complex issue. Patients have multiple etiologies for their pain and treatment often defies a standard protocol. Reports in the literature have suggested that for patients with presumed gynecologic etiologies of pain, hysterectomy is a final common pathway with a 75% cure rate. Patients in that study were not previously subjected to conservative surgery. In our population, the cumulative probability for definitive surgery after laparoscopy was 5.1% after 7.5 years.