Laparoscopic Douglasectomy in the treatment of painful uterine retroversion

Peter von Théobald, P Barjot, Gary Levy
In: Surgical Endoscopy · 1997 · vol. 11(6) , pp. 639–642 · doi:10.1007/pl00009614 · PMID:9171123 · W1968073124
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Laparoscopic Douglasectomy with uterosacral ligamentopexy was performed on 41 patients with painful retroverted uterus, resulting in pain relief for 80% and 23 subsequent pregnancies.

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This paper studied the outcome of 41 laparoscopic Douglasectomies combined with uterosacral ligamentopexy in patients with painful uterine retroversion attributed to the Masters-Allen syndrome, with patient selection guided by a “pessary test.” The procedure was performed at a single institution (1990–1995), and the authors report that 75% had total pain relief and additional patients had partial relief, with two main complications (one requiring laparotomy for bleeding and one requiring re-laparoscopy for a hematoma). A major caveat is that the study is based on a single-center case series without randomized comparison, and the authors note complications and compare the procedure to other techniques in the literature rather than directly testing them. Relevance to endometriosis: the paper focuses on pelvic pain due to uterine retroversion and Masters-Allen syndrome rather than endometriosis or adenomyosis, and it does not explicitly discuss those conditions.

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Abstract

Background: One of the etiologies of pelvic pain in women, often unrecognized, is the Masters-Allen syndrome, which was described in 1955 as the ``universal joint cervix'' syndrome. It has the following three elements: (1) etiology: obstetrics-related trauma; (2) clinical findings: uterine retroversion with hypermobile cervix following elongation or desinsertion of the uterosacral ligaments; (3) anatomy: visualization of a tearing of the posterior serosa and subperitoneal fascia of the ligamentum latum.

Methods

Forty-one laparoscopic Douglasectomies with uterosacral ligamentopexy were performed in the department of Gynecology at the University Hospital of Caen during the period between 1990 and 1995 in patients with painful retroverted uterus. The patient selection was made thanks to the ``pessary test.'' The surgical endoscopic procedure, identical to the operation first promoted by Jamain and Letessier in 1976 by laparotomy, is described.

Results

Total pain relief was experienced by 31 patients (75%) and partial relief by five patients (5%). Two main complications occurred, requiring one laparotomy (bleeding from a pelvic varicose vein with a concomitantly occurring breakdown of the washing-aspiration system) and one second laparoscopy at day 15 (one case of hematoma below the peritonization revealed by pain). Twenty-three women became pregnant again, and had normal deliveries except for two cesareans, with no recurrence of pain. Douglasectomy is compared to alternative techniques in the literature. Other indications for Douglasectomy are discussed.

Conclusion

Douglasectomy is the only definitive procedure for restoring normal anatomy of the pelvic floor in case of painful uterine retroversion occurring in a setting of Masters-Allen syndrome. Additionally, it provides for pathological analysis of the excised peritoneum. The results of this procedure are excellent when the indication is correctly set, particularly as concerns positive pessary testing. Similar content being viewed by others Author information Authors and Affiliations Additional information Received: 22 April 1996/Accepted: 15 July 1996 Rights and permissions About this article Cite this article von Theobald, P., Barjot, P. & Levy, G. Laparoscopic Douglasectomy in the treatment of painful uterine retroversion. Surg Endosc 11, 639–642 (1997). https://doi.org/10.1007/PL00009614 Published: Issue date: DOI: https://doi.org/10.1007/PL00009614

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