Efficacy of presacral neurectomy for the relief of midline pelvic pain

Abstract

Presacral neurectomy has been advocated for severe dysmenorrhea when medical therapy fails to provide adequate relief. However, there are concerns regarding efficacy and the potential for postoperative complications. In order to address these concerns, questionnaires were used to assess the levels of pain (0-5 scale) before and after laparoscopic ablation/excision of endometriosis, which in some patients included a presacral neurectomy. Patients completed a preoperative and postoperative pain assessment to rate pain at different parts of the menstrual cycle, bowel symptoms, bladder symptoms, and general level of function. To date we have evaluated the records of 371 control patients (CON) and 76 patients who underwent a presacral neurectomy (PSN). Similar proportions of patients in each group were distributed among the different stages of endometriosis: Stage I, 25% (CON), 38% (PSN); Stage II, 28%/29%; Stage III, 31%/24%; Stage IV, 17%/10%. Significant improvement (by Wilcoxon signed rank test) over preoperative pain levels was found in both groups for menstrual cramps as well as other symptoms related to endometriosis. Even when controlled for preoperative pain level, comparable degrees of pain relief were observed in both groups. These results indicate that presacral neurectomy has no substantial benefit for the relief of dysmenorrhea over laparoscopic ablation/excision alone.