49: Surgical assessment of chronic pelvic pain

Abstract

This is an educational video designed to describe indications for surgical intervention in the setting of chronic pelvic pain, and to outline tips and tricks for a thorough and successful diagnostic laparoscopy to evaluate for endometriosis. Endometriosis is a chronic inflammatory condition marked by ectopic endometrial glands and stroma. The gold standard of diagnosis is based on histologic confirmation obtained from surgical evaluation. Women with chronic pelvic pain who have failed medical management, desire conception, or who have pelvic imaging abnormalities are candidates for a diagnostic laparoscopy to evaluate for endometriosis. Initial presentation of symptoms of endometriosis to formal diagnosis is often delayed for years, which also suggests a delay in treatment. A diagnostic laparoscopy consists of a thorough evaluation of the abdominal and pelvic organs with photo documentation. Peritoneal biopsies should be collected at areas suspicious for endometriosis or other abnormalities. If no pathology is visualized, it may be prudent to collect random peritoneal biopsies for evaluation. Chromopertubation may be performed depending on the patients’ fertility goals. Perioperative counseling is crucial to discuss and evaluate for other sources of pelvic pain, review potential surgical findings and to develop a long-term treatment plan for acute and chronic pain. Chronic pelvic pain is a complex condition that requires comprehensive evaluation, inclusive of medical and surgical management.