Laparoscopic Plication and Suspension of the Round Ligament for Chronic Pelvic Pain and Dyspareunia

Abstract

Study Obrjective To describe a technique of uterine suspension using round ligaments to relieve pain in selected patients with various degrees of uterine retroversion. Design Prospective clinical study (Canadian Task Force classification II-2). Setting University-based center for reproductive medicine. Patients Thirty women who underwent laparoscopy for investigation of chronic pelvic pain (CPP) and dyspareunia. Intervention Round ligaments were plicated using a modification of intracorporeal knot tying during laparoscopy. Measurements and Main Results The extent of plication was planned to elevate the uterus and bring it minimally forward. Mean ± SD operating time was 14 ± 4 minutes. Pain scores before and after surgery were 4.5 ± 1.0 and 1.6 ± 0.6, respectively (p<0.001). There were no complications during or after surgery. Only three women had minimal dyspareunia postoperatively, although they had anteverted uteri. One patient had severe dyspareunia that developed 7 months after surgery and continued through the second year of follow-up. Nineteen women with anteverted uteri were free of dyspareunia after 2 years. Conclusion Round ligament plication is safe and effective in patients with retroverted uteri and dyspareunia or CPP.