THE ROLE OF UTEROSACRAL LIGAMENT RESECTION IN CONSERVATIVE OPERATIONS FOR RECURRENT ENDOMETRIOSIS

Fifteen patients with a history of endometriosis and recurrent pelvic pain underwent conservative resection at laparotomy. Microsurgical resection of endometriotic lesions and restoration of pelvic anatomy were performed. Presacral neurectomy was carried out in 12 of 15 (80%) patients complaining of significant midline pelvic dysmenorrhea. All patients had retroperitoneal dissections and bilateral uterosacral ligament resections regardless of whether or not there was clinical suspicion of uterosacral ligament involvement. Dysmenorrhea, dyspareunia, and dyschezia were relieved in 12 of 15 (80%), 7 of 12 (58%), and 8 of 11 (77%) patients, respectively. Eight patients (54%) had histological involvement of the uterosacral ligaments. Of this subgroup of patients, all had relief of dysmenorrhea, dyspareunia, and dyschezia postoperatively. Gross appearance was not always reliable in determining uterosacral ligament involvement. We believe that bilateral uterosacral ligament resection may benefit patients with endometriosis by improving symptoms of deeply infiltrating lesions (dyspareunia, dyschezia) in addition to the known effects of conservative resection and presacral neurectomy in alleviating dysmenorrhea. Further study of this adjunctive procedure in a prospective fashion appears warranted.