Laparoscopic Anterior Uterine Ligamentopexy for Pelvic Pain in a Selected Population of Patients

Abstract

Study ObjectiveTo evaluate clinical outcome after laparoscopic anterior uterine ligamentopexy for retroverted uterus associated with congestive pelvic syndrome (CPS). The second objective was to compare patients with and without endometriosis and their satisfaction scores.DesignIt is a descriptive single-center retrospective study that analyzed all patients who have benefited from a laparoscopic uterine anterior ligamentopexy for pelvic pain from February 2008 to April 2012.SettingGynecology Department of the University Hospital of Strasbourg, France.PatientsThirty-two consecutive patients who underwent laparoscopic anterior uterine ligamentopexy for chronic pelvic pain, dyspareunia and dysmenorrhea.InterventionA laparoscopic anterior uterine ligamentopexy was performed by one surgeon using the same surgical procedure. Combination with endometriosis was evaluated. A questionnaire was sent retrospectively to measure pain prior to, and after surgery, using an analog visual pain score (under 10). Satisfaction was evaluated out of a 100% score. For group comparisons a p value <0.05 was considered statistically significant.Measurements and Main ResultsTable 1Preoperative datasBasal CharacteristicsEndometriosis (n = 19)No endometriosis (n = 13)p valueAge29.828.90.458Parity1.11.20.497Dysmenorrhea7.66.30.183Dyspareunia7.47.30.891Chronic pelvic pain7.36.70.489All pain scores were improved after surgery. Open table in a new tab Table 2Symptoms evolutionSymptomsEndometriosis (n = 19)No endometriosis (n = 13)preop (/10)post op (/10)p valuepreop (/10)post op (/10)p valueDysmenorrhea7.62.6<0.0016.31.080.002Dyspareunia7.42.8<0.0017.31.460.001Chronic pelvic pain7.33.5<0.0016.71.920.002 Open table in a new tab There were seven reinterventions (21.87%) for persistent pelvic pain with six hysterectomies with adnexal conservation and one section of the sutures at the round ligaments, within an average of eleven months (range, 3-18). In all cases, satisfaction was high with 75.26% in the Endometriosis group and 91.53% in the No Endometriosis group.ConclusionLaparoscopic anterior uterine ligamentopexy is a simple procedure that can be useful to reduce pain even in case of endometriosis. Randomized controlled trials are mandatory to confirm our results. Study ObjectiveTo evaluate clinical outcome after laparoscopic anterior uterine ligamentopexy for retroverted uterus associated with congestive pelvic syndrome (CPS). The second objective was to compare patients with and without endometriosis and their satisfaction scores. To evaluate clinical outcome after laparoscopic anterior uterine ligamentopexy for retroverted uterus associated with congestive pelvic syndrome (CPS). The second objective was to compare patients with and without endometriosis and their satisfaction scores. DesignIt is a descriptive single-center retrospective study that analyzed all patients who have benefited from a laparoscopic uterine anterior ligamentopexy for pelvic pain from February 2008 to April 2012. It is a descriptive single-center retrospective study that analyzed all patients who have benefited from a laparoscopic uterine anterior ligamentopexy for pelvic pain from February 2008 to April 2012. SettingGynecology Department of the University Hospital of Strasbourg, France. Gynecology Department of the University Hospital of Strasbourg, France. PatientsThirty-two consecutive patients who underwent laparoscopic anterior uterine ligamentopexy for chronic pelvic pain, dyspareunia and dysmenorrhea. Thirty-two consecutive patients who underwent laparoscopic anterior uterine ligamentopexy for chronic pelvic pain, dyspareunia and dysmenorrhea. InterventionA laparoscopic anterior uterine ligamentopexy was performed by one surgeon using the same surgical procedure. Combination with endometriosis was evaluated. A questionnaire was sent retrospectively to measure pain prior to, and after surgery, using an analog visual pain score (under 10). Satisfaction was evaluated out of a 100% score. For group comparisons a p value <0.05 was considered statistically significant. A laparoscopic anterior uterine ligamentopexy was performed by one surgeon using the same surgical procedure. Combination with endometriosis was evaluated. A questionnaire was sent retrospectively to measure pain prior to, and after surgery, using an analog visual pain score (under 10). Satisfaction was evaluated out of a 100% score. For group comparisons a p value <0.05 was considered statistically significant. Measurements and Main ResultsTable 1Preoperative datasBasal CharacteristicsEndometriosis (n = 19)No endometriosis (n = 13)p valueAge29.828.90.458Parity1.11.20.497Dysmenorrhea7.66.30.183Dyspareunia7.47.30.891Chronic pelvic pain7.36.70.489All pain scores were improved after surgery. Open table in a new tab Table 2Symptoms evolutionSymptomsEndometriosis (n = 19)No endometriosis (n = 13)preop (/10)post op (/10)p valuepreop (/10)post op (/10)p valueDysmenorrhea7.62.6<0.0016.31.080.002Dyspareunia7.42.8<0.0017.31.460.001Chronic pelvic pain7.33.5<0.0016.71.920.002 Open table in a new tab There were seven reinterventions (21.87%) for persistent pelvic pain with six hysterectomies with adnexal conservation and one section of the sutures at the round ligaments, within an average of eleven months (range, 3-18). In all cases, satisfaction was high with 75.26% in the Endometriosis group and 91.53% in the No Endometriosis group. All pain scores were improved after surgery. There were seven reinterventions (21.87%) for persistent pelvic pain with six hysterectomies with adnexal conservation and one section of the sutures at the round ligaments, within an average of eleven months (range, 3-18). In all cases, satisfaction was high with 75.26% in the Endometriosis group and 91.53% in the No Endometriosis group. ConclusionLaparoscopic anterior uterine ligamentopexy is a simple procedure that can be useful to reduce pain even in case of endometriosis. Randomized controlled trials are mandatory to confirm our results. Laparoscopic anterior uterine ligamentopexy is a simple procedure that can be useful to reduce pain even in case of endometriosis. Randomized controlled trials are mandatory to confirm our results.