Endoscopic dissection of the uterosacral ligaments for the treatment of chronic pelvic pain

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Abstract
As an increasing number of women without pathological findings suffer from chronic pelvic pain (CPP) it has become necessary to use simple treatments involving relatively few complications. From January 1994 to March 1997, 108 patients with CPP underwent diagnostic laparoscopy at our unit. The most frequent findings were endometriosis (33.3%), pelvic adhesions (23.1%), Allen–Masters syndrome (3.7%) and pelvic congestion (2.8%). In 14.8% of the patients with CPP, diagnostic laparoscopy did not reveal any pathological findings in the pelvis. This latter group of patients were treated by means of dissection of the uterosacral ligaments performed at the same time as the diagnostic laparoscopy. None of them had experienced a sustained response to treatment with analgesics and psychological intervention. At 3 months after the operation 50% of the patients who presented for follow up were completely free of symptoms, with an additional 35.7% showing a significant alleviation of pain. There was little change in these percentages 12 months after treatment. No surgical complications were observed. We conclude that this procedure represents a promising alternative treatment for patients with chronic pelvic pain.