Laparoscopic Findings, Management, Histopathology, and Outcomes in 25 Women with Cyclic Leg Pain

George A. Vilos, Vilos GA, Andrew W. Vilos, Vilos AW, Haebe JJ, Jeffrey J. Haebe
The Journal of the American Association of Gynecologic Laparoscopists · 2002 · vol. 9(2) , pp. 145–151 · doi:10.1016/s1074-3804(05)60122-3 · PMID:11960038 · W2083443917
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This paper describes the laparoscopic findings, management, histopathology, and outcomes in 25 women diagnosed with cyclic leg pain.

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Abstract

Study objectiveTo determine pelvic findings, histopathology, and clinical outcome in women with chronic pelvic pain and cyclic sciatica-like pain after laparoscopic surgery.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingUniversity-affiliated teaching hospital.PatientsOf 2115 women with chronic pelvic pain, 25 also complained of cyclic pain radiating to the leg (right 15, left 9, both 1), pain over buttocks, and paresthesia of the thighs and/or knees, exacerbated during menses.InterventionLaparoscopy.Measurements and main resultsLaparoscopic findings were endometriosis nodules (5 patients), peritoneal pockets and/or peritoneal endometriosis (19), and inflammatory peritoneum (1). Associated pelvic endometriosis was identified and confirmed in 17 women (68%). No additional lesions other than peritoneal pockets were found in eight (32%). All nodules, peritoneal pockets, and abnormal peritoneum were excised with a combination of hydrodissection and carbon dioxide laser. Peritoneum over resultant deep defects was sutured with one to three 2-0 nonabsorbable sutures in accordance with the surgeon's practice and experience. Endometriosis was confirmed in all five nodules, and histology of excised pockets showed endometriosis in nine (60.0%), endosalpingiosis in two (13.3%), chronic inflammation in one (6.7%), and normal tissue in three (20.0%). After laparoscopic excision sciatic symptoms were eliminated in 19, markedly improved in 4, remained the same in 2, and recurred in 3 patients after 2 years.ConclusionCyclic leg signs and symptoms were associated with pelvic peritoneal pockets, endometriosis nodules, or surface endometriosis of the posterolateral pelvic peritoneum. We hypothesize that the pain associated with these lesions is more likely referred pain originating from pelvic peritoneum than direct irritation of the lumbosacral plexus of the sciatic nerve.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Laparoscopy Pain Pain Measurement Pelvic Pain Pelvic Pain Adolescent Adult Chronic Disease Cohort Studies Endometriosis Endometriosis Female Humans Leg Middle Aged Pain Pelvic Pain Peritoneum Peritoneum

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