Presacral neurectomy for treatment of midline pelvic pain: Laparoscopic approach with laparoscopic treatment of a single major complication

Abstract

The treatment of midline dysmenorrhea and pelvic pain with laparoscopic presacral neurectomy (LPSN) has been reported previously. In this prospective study, 27 women experienced severe midline dysmenorrhea/pain, and 12 of these women also had significant lateral pain. Other procedures including lysis of adhesions, excision/vaporization of endometriosis, and appendectomy were completed prior to LPSN. Twenty-two women reported no midline pain in follow-up 5 to 35 months postoperatively, 4 noted significant reduction of midline pain, and 1 had persistence of severe pain. Of the 12 women with lateral and midline pain, 3 had persistence of pain. Laparoscopic repair of a left common iliac vein laceration was accomplished with hemoclips. This report supports the view that LPSN is a safe and effective procedure for treating midline dysmenorrhea/pelvic pain when performed by experienced laparoscopic surgeons. Selected complications may be managed laparoscopically.