Laparoscopic Presacral Neurectomy for Chronic Central Lower Abdominal Pain after Previous Cold Knife Conization

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We desire to demonstrate an effective laparoscopic technique for presacral neurectomy and to describe an unusual clinical presentation where presacral neurectomy was deemed to be the effective treatment option for chronic central lower abdominal pain. Presacral neurectomy has been performed typically in patients with refractory primary dysmenorrhea and in patients with endometriosis in conjunction with resection of endometriosis. Small studies have demonstrated modest improvement in pain with laparoscopic presacral neurectomy compared to laparoscopic uterosacral nerve ablation for primary dysmenorrhea and compared to surgical treatment of endometriosis alone. Some have proposed a preoperative hypogastric nerve block to determine which patients would be an appropriate candidate for presacral neurectomy. Our patient had chronic central lower abdominal pain after a cold knife conization 4 years previously. She had temporary relief after injection of her superior hypogastric plexus by an interventional pain specialist. One month post-operatively she was pain free.