Razia Iftikhar.
Outcome of Laparoscopy in chronic pelvic pain.
J Surg Pak Jan ;13(4):155-8.

Objective To find out efficacy of laparoscopy in evaluation and treatment of chronic pelvic pain (CPP) in gynecologic patients in terms of arriving at diagnosis. Study design: Observational study. Place & Duration of study: Department of Obstetrics and Gynaecology Baqai Medical University Karachi, from July 2006 to July 2008. Patients and Methods: A total of 30 patients were selected for laparoscopy. Women aged between 20-48 years were included in the study. Pain level was assessed by interviewing patients. Pain level was rated at a scale of 1 to 10 (1=no pain, 10=severe pain). Activity level was also assessed in a similar manner. Laparoscopic surgery was designed to restore normal pelvic anatomy. Patients were completely evaluated for other causes of pain i.e. gastrointestinal, urological, myofacial and musculoskeletal causes. Patients suitable for medical treatment were put on hormones before and after surgery and results observed after 1, 3 and 6 months. Results Endometriosis was found in 17 (56.6%) cases. Deep endometriotic lesions were treated by electrosurgical excision. Lesions on bowel were resected in collaboration with general surgical colleagues. Patients who had extensive endometriosis were selected for medical therapy with gonadotropic releasing hormones for 3 months after laparoscopy. Pelvic adhesions distorting the tubes were found in 5 (16.6%) cases. These were treated by sharp dissection. Bowel adhesion and adhesions between appendix and uterus were found in 1 (3%) case. In this case adhesiolysis was done and appendix was also removed. Two (6.6%) cases had benign ovarian cyst and were removed. Two (6.6%) cases had polycystic ovarian disease and drilling was performed. Three (4%) patients had negative laparoscopy and were reevaluated for other causes of CPP. Five (16.6%) cases underwent hysterectomy for persistent pelvic pain 6 months after laparoscopy. Conclusions Laparoscopy is a useful procedure both in evaluation and treatment of chronic pelvic pain.

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