LAPAROSCOPIC EVALUATION AND TREATMENT OF WOMEN WITH CHRONIC PELVIC PAIN

Study Objective. To evaluate the effectiveness of operative laparoscopic treatment at the time of diagnostic laparoscopy in patients with chronic pelvic pain (CPP). Design. A retrospective study of women with CPP and at least 6 months of follow-up after laparoscopic evaluation and treatment. Setting. A faculty practice and community teaching hospital. Patients. A series of 65 consecutive women with greater than 1 month of pelvic pain who underwent laparoscopy. Thirty-two were referred by other physicians for evaluation of CPP. Interventions. Patients had operative laparoscopic treatment of all abnormal findings at the time of diagnostic laparoscopy. Nonspecific treatment such as presacral neurectomy or uterine nerve ablation was not performed. Measurements and Main Results. After laparoscopic evaluation and treatment, 78% of patients had decreased pain and 45% were pain free. Prior unsuccessful medical or surgical treatment did not affect the response rate. Endometriosis and adhesive disease were the most common diagnoses, 38% and 34%, respectively. Conclusions. Laparoscopic surgical treatment of pathology noted at the time of diagnostic laparoscopy in women with CPP is appropriate, but less than one-half of patients may be expected to have complete pain relief.