Efficacy of Laparoscopic Pelvic Denervation in Central-Type Chronic Pelvic Pain: A Multicenter Study

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Abstract
Our aim was to evaluate the efficacy of laparoscopic pelvic denervation (uterosacral resection or presacral neurectomy) for the treatment of chronic pelvic pain with a predominant central-type localization in women with endometriosis or with no visible pathology. In a retrospective analysis performed in six centers, we evaluated the data relative to 58 patients with midline pelvic pain laparoscopically treated, with a follow-up of at least 6 months including a quantitative pain assessment. The distribution of types of pain (dysmenorrhea, deep dyspareunia, and pelvic pain not related to menses or coitus) was not different among stage I–II endometriosis, stage III–IV endometriosis, and no visible pathology, except that deep dyspareunia was significantly (p < 0.05) less frequent in the absence of visible pathology than in moderate to severe endometriosis. Both types of laparoscopic denervations significantly (p < 0.001) reduced after 6 months the intensity of midline dysmenorrhea, pelvic pain, and deep dyspareunia in both endometriosis patients who also had undergone conservative surgery and women without any laparoscopically visible pathology. Presacral neurectomy was significantly more effective than uterosacral resection in the relief of dysmenorrhea. No major adverse effects were reported; and minor side effects were comparable between the two techniques. In conclusion, both presacral neurectomy and laparoscopic uterosacral resection are highly effective in reducing midline pelvic pain performed either alone or in combination with the classic ablative surgery for endometriosis. (J GYNECOL SURG 12:35, 1996)

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