Laparoscopic management of Post-Hysterectomy chronic pelvic pain and deep dyspareunia

Abstract

Study objective: To evaluate the outcome of laparoscopic management post-Hysterectomy chronic pelvic pain and its managements. Materials and methods: This is a retrospective study of 50 consecutive patients who underwent laparoscopy for post hysterectomy chronic pelvic pain and dysparunia. At laparoscopy the causes are Intrinsic vaginal apex pain, Postoperative adhesions, Residual ovary syndrome, Ovarian remnant syndrome, Pre-existing or recurrent endometriosis, bladder, bowel, or sexual dysfunction, Chronic appendicitis and pelvic congestion syndrome. Operative Laparoscopic treatments done according to causes are excision of full thickness vaginal vault along with scar tissue or any chocolate or resuadal cyst and appendectomy. The vaginal cuff was closed laparoscopically. The patients were assessing their pain, general health, quality of life, and satisfaction with the surgery. The mean interval from vaginal vault excision and assessment was 1.8 years. Results: The mean age of the women was 35 years. All women had vaginal vault tenderness on examination and underwent laparoscopic vaginal vault excision. The only intraoperative complication was 2 injury of the bladder. A single or a combination of additional procedures was performed at the same time. All the patients were satisfied. The mean pain scores decreased, and quality of life and general health improved significantly after vaginal vault excision (p < .05, t test). Conclusion: Diagnostic and operative laparoscopy is the standard managements for chronic pelvic pain and deep dyspareunia Laparoscopic vaginal apex excision is a safe and effective management option after carefully excluding other causes of deep dyspareunia and chronic pelvic pain. It also provides an opportunity to detect and surgically excise previously undiagnosed endometriosis and other disease.