Surgical Management of Pelvic Pain

Surgical management of chronic pelvic pain (CPP) is ideally performed when medical management has failed and a surgically correctable pain source has been identified. In reality, the cause of chronic, nonmalignant pain is often difficult to diagnose, particularly when no ongoing tissue damage or noxious stimulus is evident. In addition to performing a technically correct surgery, therefore, appropriate preoperative patient assessment, procedure selection, and patient counseling are critical to the overall success of the surgery. Before resorting to diagnostic or therapeutic surgery, a meticulous history and physical examination should be performed to identify nonsurgical and nongynecological causes of pain. Although laparoscopy is frequently used to evaluate patients with CPP, its effect on long-term outcome variables needs further study. In a review by Howard, 61% to patients with CPP had pathology at laparoscopy opposed to 28% in the control group.1 Less than 50% of these women, however, experienced long-term pain relief. The discovery of pathology may therefore be a surrogate endpoint, whereas true surgical success should be measured by a patient’ s ability to function. Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

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