Laparoscopy For Chronic Pelvic Pain Research Articles

Role of diagnostic laparoscopy in chronic pelvic pain in females: A study from tertiary care centre in Patna, Bihar

Chronic pelvic pain in females is one of the most bemusing problems that are faced by doctors in day to day practice as physical signs are nonspecific. Laparoscopy is one of the worthy tools in cases of chronic pelvic pain as not only it establishes the diagnosis but often treatment can be instituted in the same sitting. The present study aimed to evaluate whether diagnostic value of laparoscopy is worth in cases with chronic pelvic pain in females.This study was done in the department of General Surgery and Reproductive Medicine at Indira Gandhi Institute of Medical sciences, Patna, Bihar from July 2019 to March 2021. Seventy five female patients were included in this study. The analysis and interpretation of the data were performed using Microsoft excel. The quantitative data obtained were expressed as percentage in tabular form.: The studied patients were in the age group ranging from 15 – 65 years. Most patients 40 % (n=30) complaint of pain in right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to be tubercular pathology (22.67%) followed by pelvic adhesions (18.67%). Other diagnoses were pelvic inflammatory disease, endometriosis, cysts etc.Diagnostic Laparoscopy is a safe and effective tool to establish the aetiology of chronic pelvic pain and allows for appropriate interventions. It can serve as a time saving and cost effective implement for these patients with uncertain diagnosis.

Laser-Assisted Appendectomy

Endometriosis is a common gynaecologic condition affecting 10% of people with uteruses and up to 70% of those with chronic pelvic pain. Appendiceal endometriosis is common and pre-operative diagnosis is challenging. This video reviews prevalence of appendiceal endometriosis, highlights important anatomical landmarks for appendectomy and demonstrates a novel technique for laparoscopic appendectomy using a CO2 Laser at the time of surgical management of endometriosis. The laser appendectomy approach is reviewed in 4 steps, addressing preoperative and intraoperative considerations. This video can be used as a reference for gynaecologists when performing appendectomy at the time of hysterectomy or diagnostic laparoscopy for chronic pelvic pain.

The effect of laparoscopy in chronic pelvic pain on quality of life

Chronic pelvic pain (CPP) is a problem facing gynecologists. Laparoscopy is a minimally invasive surgical technique used for both diagnosis and treatment of CPP. This study aimed to investigate the determination of women with pelvic pain who will benefit from diagnostic laparoscopic surgery and its effect to on quality of life. A prospective designed study conducted between October 2013 - August 2015 including 90 patients at University of Health Sciences, Zekai Tahir Burak Women Health Care, Training and Research Hospital, Turkey. While 45 patients in reproductive age with complaints of non-cyclic pelvic pain for more 6 months constituted the study group, 45 patients with no active complaints who admitted for laparoscopic tubal ligation constituted the control group. Short Form-36 (SF-36) and Visual Analog Scala (VAS) Questionnaire was applied to patients in preoperative and postoperative periods. While VAS score in study group patients before surgery was 6,91±0,92, it was 4,33±1,64 after surgery (p<0.001). In addition, there were statistically significant difference between SF-36 Physical Health and SF-36 Mental Health scores before and after surgery. There was a significant improvement in quality of life in the study group. Laparoscopic approach should be preferred for direct visualization and immediate treatment in patients with CPP. Laparoscopy keeps its importance for patients with CPP, improving quality of life.

The Role of Diagnostic Laparoscopy in Chronic Pelvic Pain

One of the commonest symptomatology in gynecological outpatient clinics is chronic pelvic pain, it accounts for 10% of gynecologist’s general clinics patients. The study aimed to To evaluate the role of laparoscopy in evaluation of CPP, and its correlation with clinical examination and vaginal ultrasound examination. The present prospective study was done in the Department of Obstetrics and Gynecology Salah Al-Deen general hospital in Tikrit city from 1stApril- 31st August 2020. The study sample consists of 30 patients with chronic pelvic pain, according to the ACOG criteria, with a convenient sampling method. The data collection done through: a designed closed and open-ended questionnaire, physical examination, transvaginal ultrasound & laparoscopic examination for the 30 patients for evaluation of chronic pelvic pain. By laparoscopic examination (90%) of patients had positive findings, pelvic examination identified (89%) of them correctly. Those with negative findings in laparoscopy was (10%) of patient, (33.3%) of them were diagnosed as negative by pelvic examination, there were miss diagnosis in (67%) of the negative patient and (11.1%) of positive diagnosed patient, this was a statically significant relation. Sensitivity of TVS was 85%, versus 89% for the pelvic examination. Specificity for TVS, and pelvic examination was (100%), (33%) respectively. Accuracy of the test for TVS, and pelvic examination was (87%), (83%) respectively. Exploratory laparoscopy provides a definitive diagnosis in 90% of women complaining of unexplained CPP. The surgical treatment of these lesions improves painful symptomatology in 70% of women .

Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain.

To determine the prevalence of occult microscopic endometriosis in patients with chronic pelvic pain and negative laparoscopy. A retrospective cross-sectional study included women who underwent laparoscopic evaluation for chronic pelvic pain by three fellowship-trained gynecologic surgeons at a community hospital from January 2011 to December 2016. The aim was to evaluate the prevalence of microscopic endometriosis in this population. In 142 patients with clinically negative peritoneum on laparoscopy, 39% had occult microscopic endometriosis. Cramping pain score during menses was found to be lower in the positive biopsy group (6.9 vs 8.0, P=0.046). No differences were appreciated in age of menarche, pain during various parts of the menstrual cycle, or duration of symptoms. The biopsy-positive group had a younger age at time of evaluation, although not statistically significant (P=0.179). Current use of hormones affected neither biopsy results nor menstrual or pain characteristics. Detection was similar between robotic and laparoscopic cases and operative morbidity was minimal. Occult microscopic endometriosis may be present in approximately 39% of patients with clinically negative appearing peritoneum undergoing laparoscopy for chronic pelvic pain. Given this, biopsies should be performed in patients undergoing laparoscopy who do not have visible lesions.

Role of Diagnostic Laparoscopy in Chronic Pelvic Pain

Introduction: Chronic pelvic pain is non cyclic pain of six or more months duration that localizes to the anatomical pelvis, anterior abdominal pain at or below umbilicus, the lumbosacral back, or the buttocks, and is of sufficient severity to cause functional disability or lead to medical care1.Chronic pelvic pain is one of the most common gynecological symptoms and one of the most important in terms of social costs Objective: To study the role of diagnostic laparoscopy in chronic pelvic pain. To compare the findings of laparoscopy in patients of chronic pelvic pain and patients undergoing routine laparoscopic tubal ligation. Materials and Method: This study was conducted at Saraswathi institute of medical sciences(HAPUR,U.P) during the period between January 2018 to December 2019. Total 110 cases were enrolled.55 cases whohad been suffering from chronic pelvic pain for 6 months (or more) were taken as study group-(A).55cases without any symptoms who underwent laparoscopic sterilization were taken as control group-(B). Results: 10.60% cases with chronic pelvic pain had normal findings whereas 25.25% cases were normal on laparoscopy. Endometriosis was suspected in 7.27% cases on ultrasonography, where as it was confirmed on laparoscopy in 18.1%.Similarly PID was suspected in 12.72% cases whereas it was confirmed on laparoscopy in14.54% cases. Conclusion: In our study we could conclude that the treatment of cases of chronic pelvic pain post diagnostic laparoscopy are adhesiolysis, endometriotic cyst removal, Ovarian Cystectomy and Hydrosalpinx.

Incidental primary peritoneal serous borderline tumor miming endometriosis during laparoscopy for chronic pelvic pain

Incidental primary peritoneal serous borderline tumor miming endometriosis during laparoscopy for chronic pelvic pain

Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria

Background: Endometriosis is a complex gynecological disease in its physiopathological aspects and clinical implications. Signs and symptoms include pain and subfertility. The most common sites are pelvic organs and peritoneum. This study evaluated the prevalence of endometriosis among women undergoing diagnostic laparoscopy for chronic pelvic pain and infertility at a tertiary hospital in North-Western Nigeria over a 3-year period (from January 1, 2015, to December 31, 2017). Materials and Methods: A retrospective study of women who had diagnostic laparoscopy for chronic pelvic pain and infertility in our hospital was conducted. Theater operation register records and files of women who had laparoscopy for the same indications were retrieved and reviewed. Information on sociodemographic and reproductive characteristics as well as laparoscopic findings were extracted and reviewed. Results: The total number of women who had laparoscopy for the above indications over the study period was 92, of which 74 files were retrieved and analyzed. The prevalence of endometriosis was found to be 8.1%. Endometriosis was found to be more common in women whose complaint was chronic pelvic pain and/or dysmenorrhea. Conclusion: Endometriosis is a common, underreported gynecologic condition among women of reproductive age group presenting with infertility and chronic pelvic pain.

Endometriosis in Adolescence: Challenges and Opportunities for Managing Future Infertility

Endometriosis is defined as the presence of endometrial stroma and glands outside the normal uterus. The prevalence of endometriosis in adolescents undergoing laparoscopy for chronic pelvic pain is reported to be between 19% and 73%. Interestingly, endometriosis has also been identified in premenarcheal girls with some breast development. Several factors have been incriminated for endometriosis, while no single theory can explain the variety of symptoms. Genetic factors seem to play a role, while lifestyle characteristics and environmental factors are likely related to the development of the disease. The main symptoms during diagnosis of endometriosis in adolescence, is chronic pelvic pain (27%-96%) and dysmenorrhea (18%-100%). Medical history and clinical examination are of great importance, while imaging exams are very helpful during evaluation of these girls, while endometriosis can only be diagnosed by visual inspection during laparoscopy, ideally confirmed by histology. Treatment options include not only medical regimens, with Non-Steroidal-Anti-Inflammatory Drugs and Combined Oral Contraceptives been the most common used, and other medications such as Danazol, Progestins, GnRH agonists with Add-Back therapy and cyproterone acetate, but also surgical treatment. Surgical management alone or in combination with postoperative hormonal suppression seems to improve future fertility options of adolescents with endometriosis.

The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution.

Clinician and patient factors impact on the management of chronic pelvic pain (CPP) with medical, surgical or combined approaches possible, although none have proven superior. To understand the characteristics of women offered laparoscopic pelvic surgery for CPP. We performed an observational study of women referred with CPP. They were asked to complete a study questionnaire regarding their symptoms, medical history, quality of life and pain catastrophisation. Examination and ultrasound findings were collected from patient records. Gynaecologists who recommended a laparoscopy completed a survey detailing their reasoning at the time of booking. The outcomes were investigated using a Cox proportional hazards ratio (HR) model. Of 211 participants, 59 (28%) were booked for laparoscopic surgery during the study timeframe. Factors increasing the rate of laparoscopy included severe dysmenorrhoea (Cox HR=1.94; P=0.017), unsuccessful trial of hormonal therapy (Cox HR=1.81; P=0.044), prior abdominal surgery (Cox HR=1.79; P=0.030), prior pelvic laparoscopy (Cox HR=2.00; P=0.007) and past diagnosis of endometriosis (Cox HR=5.44; P=0.010). Abnormal vaginal examination (Cox HR=2.86; P=0.019) and ultrasound probe tenderness (Cox HR=2.52; P<0.001) also increased the likelihood of surgery. Surgical and non-surgical patients did not differ in family history, quality of life or pain catastrophisation. Of gynaecologists' questionnaires, 75% were returned. Results indicated they were most influenced by the severity or duration of pain and least by examination or ultrasound findings. The characteristics of women booked for surgery were in keeping with the features evidence suggests increases the risk of pathology. There were some discrepancies between patient characteristics elicited in the questionnaires and those indicated by gynaecologists to influence their decision.

524 - Incidental Finding of Neuroendocrine Tumor of the Appendix in the Setting of Chronic Pelvic Pain

Study Objective: To describe the incidental finding of neuroendocrine tumor (carcinoid) of the appendix in normal appearing appendectomy specimens removed during laparoscopy for chronic pelvic pain.

Faisabilité de la cœlioscopie gynécologique en ambulatoire. Une étude prospective à propos de 50 cas

To evaluate the feasibility of outpatient laparoscopy in gynaecology. This prospective monocentric study included 50 patients. Postoperative pain was evaluated by the visual analogic scale (VAS). Reasons for hospital stay and emergency consultation rates in the first postoperative month were noted. Patient's satisfaction was recorded at the postoperative visit one month after the intervention. The following procedures were included in the study: cystectomy, oophorectomy±salpingectomy, explorative laparoscopy for chronic pelvic pain and tubal sterilization. Mean operative time never exceeded 90 minutes (mean 60±26.5min). A resident performed 70% of the procedures. No intraoperative complication was reported. Only one patient stayed hospitalised overnight. On the first and second postoperative days, the VAS was 4.89 (±2.25) and 4.14 (±2.20) respectively. Twenty-five patients (50%) were very satisfied of the medical care, 23 patients (46%) were satisfied and one patient (2%) was not much satisfied. The outpatient laparoscopy in gynaecology seems feasible with a high level of satisfaction. It can be proposed to patients after good information.

A Comparative Study of Transvaginal Sonography versus Laparoscopy Evaluation in Chronic Pelvic Pain: Original Study

Introduction: Chronic pelvic pain (CPP) is intermittent or constant pain in the lower abdomen or pelvis for at least six months duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. This chronic pelvic pain (CPP) is poorly understood, and may have significant impact on a woman’s health. Transvaginal sonography (TVS) and laparoscopy are useful in the evaluation of women with CPP. This research was designed to study role of TVS and diagnostic laparoscopy in chronic pelvic pain. Materials and Methods: This prospective study was done at Lalla Ded Hospital from August 2011 to July 2014. All female patients who had clinical diagnosis of CPP were evaluated with the TVS and laparoscopy and findings were recorded. Results: Total of 80 women had CPP. Normal TVS was present in 41 cases (51.25%). The remaining 39 (48.75%) had an abnormal scan. Laparoscopic confirmation of pelvic pathology was reported in 40 cases with abnormal scan but normal scan was confirmed only in 10 (12.50%) cases. Conclusion: In spite of similar specificity and positive predictive value, laparoscopy although being an invasive procedure still has got distinct advantages over TVS in terms of sensitivity and negative predictive value indicating its superiority in management.

Laparoscopic Appendectomy in Women Without Identifiable Pathology Undergoing Laparoscopy for Chronic Pelvic Pain

To assess the effectiveness of appendectomy in women undergoing laparoscopy for chronic pelvic pain without identifiable pathology. This retrospective cohort study included women aged 15 to 50 years who underwent laparoscopic surgery for chronic pelvic pain without identifiable pathology. The cohort was divided into 2 groups: women who underwent appendectomy and women who had not undergone appendectomy at laparoscopic surgery. Postoperative pain was assessed at 6-week follow-up and by subsequent mailed questionnaire. Women who underwent appendectomy (n = 19) were significantly more likely to report improvement in pain at 6-week follow-up than women who did not undergo appendectomy (n = 76) (93% vs 16%; P < .001). Thirty-six patients (38%) responded to the questionnaire at a median of 4.2 years after surgery, when the median change (improvement) in reported pain was greater in the appendectomy group than in the nonappendectomy group. Appendectomy is effective therapy for patients with chronic pelvic pain of unknown etiology who are undergoing laparoscopy.

Obstacles And Pitfalls Of Endometriosis-Related Chronic Pelvic Pain Management: Trying To Alleviate The Burden

Chronic Pelvic Pain (CPP) could be defined as the presence of non-cyclic pain of 6 months duration or longer that localizes to the pelvis and is severe enough to cause functional disability and require medical or surgical treatment. Among women who undergo laparoscopy for CPP, endometriosis results in approximately 1/3 of the cases; conversely, among women who do not have CPP, endometriosis is present in only 5% of cases. Moreover, accumulating evidences support the opinion for which CPP has poor correlation with endometriosis stage, moderate correlation with isolated presence of ovarian endometrioma, strong correlation with Deep Infiltrating Endometriosis (especially if it affects bowel or urinary tract) and/or adhesion. Endometriosis-related CPP could arise through different pathways: one of the clearest reason is that endometriotic lesion could provoke a compression or infiltration of nerves; another possible causes of arising CPP could be represented by the increase of Nerve Growth Factor (NGF) in the endometriotic lesion area; last but not least, CPP could arise and be exacerbated also by inflammation of the peritoneal microenvironment. The hormonal therapies do not eliminate the endometriotic implants and, for this reason, stopping the treatment pelvic pain and other typical symptoms of endometriosis may recur and exacerbate the pre-treatment condition. The surgical treatment of endometriosis-related CPP is still not perfectly encoded, due to the unclear etiology and the different response to therapies. For these reasons, there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis and treatment of the causes of endometriosis-related CPP.

The role of gynecological, urological, and psychiatric factors in chronic pelvic pain

In this study, the effectiveness of diagnostic laparoscopy, one of the methods used in the diagnosis and treatment of chronic pelvic pain, was investigated by the etiological examination of patients with chronic pelvic pain, who were treated and followed up on our clinic, allowing for gynecological, urological, and psychological factors. In this study, the importance of diagnostic laparoscopy in chronic pelvic pain was assessed in 44 patients diagnosed with chronic pelvic pain between September 2005 and May 2006. Additionally, the records of 31 patients who did not have pelvic pain and on whom laparoscopy was performed due to tubal ligation at the same time were assessed. The study group and the control group were compared in terms of laparoscopic findings. There were laparoscopic findings in 38 (86 %) of the 44 patients in the study group and pathological findings in 13 (41 %) of the 31 patients in the control group. Differences between the groups were statistically significant (p < 0.05). Chronic pelvic pain is a syndrome in which biological and psychosocial factors play a role. Laparoscopy for chronic pelvic pain is an operation based on the "see and fight" principle.

CA 125 Modifications Throughout Menstrual Cycle and following GnRH-Analog Administration to Diagnose Endometriosis as Cause of Chronic Pelvic Pain. A Prospective Controlled Study

Purpose Endometriosis is the leading single cause of chronic pelvic pain (CPP). To date, the gold standard to diagnose this condition is histologic confirmation of lesions obtained by surgery. However, a noninvasive and cheaper tool for early diagnosis is strongly needed. The aim of this study is twofold: first, to assess the diagnostic accuracy to detect endometriosis of serum CA 125 modifications throughout the menstrual cycle, and second, to analyze whether variations in CA 125 levels following one dose of GnRH-analog (GnRH-a) may increase the diagnostic value of the assay. Methods 84 women scheduled for a diagnostic laparoscopy for CPP (group A) and another 12 women scheduled for diagnostic laparoscopy for unexplained infertility (group B) were enrolled as cases and controls. Serum CA125 was determined for each patient at the early follicular and luteal phases. Prior to surgery, patients from group A received one vial of leuprolide acetate depot. Following laparoscopy and histologic examination, cases were sub-grouped into group A1 (subjects with endometriosis) and group A2 (subjects without endometriosis). Results Plasma CA125 levels during the early follicular phase were significantly higher than those recorded in the luteal phase in all groups and they were significantly higher in group A1 in comparison with groups A2 and B. One month after GnRH administration, a significant reduction in plasma CA-125 levels was only observed in group A1. Conclusions The assessment of serum CA 125 modifications throughout the menstrual cycle and following one dose of GnRH-a demonstrated good diagnostic accuracy to detect endometriosis in patients with CPP. Women with endometriosis are characterized by a significant increase in CA125 levels during the early follicular phase and by a significant decrease following GnRH-a administration.

OC10.04: Can we predict posterior compartment deep infiltrative endometriosis using sonovaginography in women undergoing laparoscopy for chronic pelvic pain?

OC10.04: Can we predict posterior compartment deep infiltrative endometriosis using sonovaginography in women undergoing laparoscopy for chronic pelvic pain?

Plasminogen activator inhibitor-1 4G/5G polymorphism and susceptibility to endometriosis in the Italian population

Objectives Some controversy exists for the potential association of the plasminogen activator inhibitor-1 (PAI-1) gene polymorphism 4G/5G and susceptibility to endometriosis. To clarify this issue, we have examined the prevalence of this polymorphism in a case–control study in the Italian population. Study design The PAI-1 4G/5G polymorphism was evaluated in n = 368 reproductive year aged Caucasian women who underwent gynaecological laparoscopy for chronic pelvic pain, infertility, ovarian cysts and myomas. A second group of controls included n = 329 normal subjects. Results The 697 women enrolled were divided as follows: the endometriosis group ( n = 204), the gynaecological control group ( n = 164) and the general population control group ( n = 329). No statistical significant differences emerged between endometriosis patients and gynaecological controls with regard to the allele frequencies and co-dominant and dominant models of genotype distribution. A borderline statistical difference was only observed for the recessive model of inheritance in which, contrary to previous findings, the PAI-1 4G/4G genotype seems to be less linked to the disease development. Conclusion The findings reported herein do not support the previously reported data indicating a greater susceptibility to endometriosis in patients harbouring the PAI-1 4G/5G and 4G/4G genotypes and exclude a significant role of polymorphism in endometriosis development.

Can specific pain symptoms help in the diagnosis of endometriosis? A cohort study of women with chronic pelvic pain

To investigate whether different dimensions of chronic pelvic pain are useful in the diagnosis of endometriosis. A prospective questionnaire-based study of 185 women. Southeast of England. Women undergoing a diagnostic laparoscopy for chronic pelvic pain. Preoperative questionnaire. Descriptions of pain, areas of pain, and pain intensity. One hundred thirteen women (61%) had histologically confirmed endometriosis. Three pain descriptors were reported more commonly by women with endometriosis: throbbing, gnawing, and dragging pain to the legs. Compared with women with superficial endometriosis, those with deep disease were more likely to report shooting rectal pain and a sense of their insides being pulled down. Individual pain areas were unrelated to the surgical diagnosis. Area of pain was unrelated to area of endometriosis. Pain intensity was unrelated to the surgical diagnosis. Dyschezia was more severe in women with endometriosis. Women with endometriosis are more likely to report their pain as throbbing and experience dyschezia when compared with women with an apparently normal pelvis. These dimensions of pain may usefully contribute to the diagnostic picture.