Laparoscopic Treatment of Uterine Retroversion Associated with Pelvic Pain: Results of 22 Cases

Abstract

Study Objective: Evaluate clinical outcome after laparoscopic anterior ligamentopexy for retroverted uterus associated with pelvic pain.Design: Prospective study, duration of the study is 36 months, mean follow up is 19 months.Setting: Strasbourg University Hospitals and IRCAD/EITS.Patients: We found the association of chronic pelvic pain, retroverted uterus, pain relief with ventral decubitus and no other obvious etiologies for pelvic pain in many patients presenting to our department. 22 patients presented the four criteria and were enrolled in this study.Intervention: Intraoperative correction of uterine retroversion by pulling ventrally on the round ligaments is first done. The change of uterus'color from purple to pink-red is required so that laparoscopic anterior ligamentopexy is performed. Two inscisions of 1.5 cm are done in each iliac fossa. The rectal aponeurosis is opened and a Kocher clamp is passed through the internal inguinal ring. The round ligaments are grasped and attached to the rectal aponeurosis with non absorbable suture. Local anaesthetics are injected under the aponeurosis and in the round ligaments at their attachments to the aponeurosis.Measurements and Main Results: Pre operative and post operative pain scores are assessed by visual analogous scale. Type and postoperative duration of use of pain killers are also noted. Fertility data and subsequent surgeries for other abdominal pathologies are collected. Results are still ongoing.Conclusion: Preliminary result analysis show good results for pain control after laparoscopic anterior ligamentopexy. Since pelvic pain associated with uterine retroversion is still a challenging and controversial pathology to diagnose and treat, randomised controlled study are mandatory. Study Objective: Evaluate clinical outcome after laparoscopic anterior ligamentopexy for retroverted uterus associated with pelvic pain. Design: Prospective study, duration of the study is 36 months, mean follow up is 19 months. Setting: Strasbourg University Hospitals and IRCAD/EITS. Patients: We found the association of chronic pelvic pain, retroverted uterus, pain relief with ventral decubitus and no other obvious etiologies for pelvic pain in many patients presenting to our department. 22 patients presented the four criteria and were enrolled in this study. Intervention: Intraoperative correction of uterine retroversion by pulling ventrally on the round ligaments is first done. The change of uterus'color from purple to pink-red is required so that laparoscopic anterior ligamentopexy is performed. Two inscisions of 1.5 cm are done in each iliac fossa. The rectal aponeurosis is opened and a Kocher clamp is passed through the internal inguinal ring. The round ligaments are grasped and attached to the rectal aponeurosis with non absorbable suture. Local anaesthetics are injected under the aponeurosis and in the round ligaments at their attachments to the aponeurosis. Measurements and Main Results: Pre operative and post operative pain scores are assessed by visual analogous scale. Type and postoperative duration of use of pain killers are also noted. Fertility data and subsequent surgeries for other abdominal pathologies are collected. Results are still ongoing. Conclusion: Preliminary result analysis show good results for pain control after laparoscopic anterior ligamentopexy. Since pelvic pain associated with uterine retroversion is still a challenging and controversial pathology to diagnose and treat, randomised controlled study are mandatory.