Are the long-term adverse effects of laparoscopic presacral neurectomy for the management of central pain associated with endometriosis acceptable?

Objective: To assess the long-term genitourinary and gastrointestinal complaints following presacral neurectomy.Design: A prospective postoperative follow-up of patients who underwent laparoscopic presacral neurectomy and treatment of endometriosis.Materials and Methods: The mean follow-up of the 67 women (mean age 27.5 years, range 16-58 years) was an average of 36.8 months with a range of 6-69 years. Main outcome variables include diarrhea, constipation, bladder and urinary complaints, vaginal dryness, dyspareunia, and orgasm. The degree of pain and dysmenorrhea after surgery was also elevated.Results: Diarrhea was reported to have improved after surgery in 39.1% of the patients and none reported any worsening. Constipation improved in 28.6% and worsened in 12.5%. Only one patient suffered from debilitating constipation. Bladder and urinary problems were improved on 25.0% and worsened in 19.2%. A similar proportion of women (19.6%) reported improvement and worsening vaginal dryness. Pain during intercourse improved in 58.9% and worsened in 8.9%. The ability to achieve orgasm improved in 21.6% and worsened in 2.7%. Postoperatively, pain was improved by 80-100% in 46.6% of the women, by 50-80% in 36.5%, by less than 50% in 6.4%, and did not improve in 9.5%. Dysmenorrhea was improved by 80-100% in 35.2% of the women, by 50-80% in 38.8%, by less than 50% in 14.9%, and did not improve in 11.1%. Twelve of 16 patients trying to become pregnant were successful following surgery, two with the aid of in vitro fertilization.Conclusion: After laparoscopic presacral neurectomy, constipation and bladder and urinary problems were reported to have worsened in only a minority of patients. However, diarrhea and dyspareunia improved in a large proportion of patients. Since pelvic pain was relieved by more than 50% in 83.1%, the procedure seems to be associated with an acceptable rate of long-term side effects.