Postoperative Pelvic Pain Research Articles

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Intrathecal Morphine Injection for Postoperative Analgesia Following Gender-Affirming Pelvic Surgery: A Retrospective Case-Control Study.

Background Gender-affirming pelvic surgery (GAPS) can be associated with significant postoperative pelvic pain. Given the lack of available peripheral nerve blocks to the perineum, intrathecal morphine (ITM) injection could offer a potent analgesic modality for this patient population. No prior studies to date have been performed examining the analgesic effects of intrathecal morphine for these patients. Methods This retrospective case-control study aims to understand the postoperative analgesic effects of intrathecal morphine for these patients with a historical comparison group of patients who did not receive intrathecal morphine. Results Fourteen patients presented for gender-affirming pelvic surgery over an eight-month period at a single institution and were offered intrathecal morphine for postoperative analgesia. Their analgesic results were compared to a similar historical group of 13 patients who were not offered or declined intrathecal morphine. Conclusions Intrathecal morphine injection is a potent analgesic modality for patients presenting for gender-affirming pelvic surgery.

Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids

BackgroundThe most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion.MethodsA retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05.ResultsThere was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups.ConclusionSeromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study.

IntroductionLaparoscopic sacral colpopexy is the gold standard technique for apical prolapse correction but it is a technically challenging procedure with rare but severe morbidity. Laparoscopic high uterosacral ligament suspension could be a valid technically easier alternative using native tissue.Material and MethodsIn the period from 2015 to 2018, 600 women were submitted to laparoscopic sacral colpopexy while 150 to laparoscopic high uterosacral ligament suspension in three Italian urogynecology referral centers. We enrolled women with apical prolapse stage ≥2 alone or multicompartment descensus. To reduce allocation bias, we performed a propensity matched analysis. Women undergoing laparoscopic high uterosacral ligament suspension surgery were matched 1:2 to women undergoing laparoscopic sacral colpopexy. The cumulative proportion of relapse-free women in time was analyzed by the Kaplan–Meier method. The primary objective of this multicenter case-control retrospective study was to compare the recurrence rate while the secondary objectives were to compare feasibility, safety, and efficacy of laparoscopic sacral colpopexy and laparoscopic high uterosacral ligament suspension in surgical treatment of pelvic organ prolapse.ResultsThree hundred and nine women were enrolled (103 laparoscopic high uterosacral ligament suspension; 206 laparoscopic sacral colpopexy). Median operatory time was significantly shorter in the laparoscopic high uterosacral ligament suspension group (P = 0.0001). No statistically significative difference was found in terms of estimated blood loss, admission time, intraoperative, and major early postoperative complications, postoperative pelvic pain, dyspareunia and de novo stress urinary incontinence. Surgical approach was the only independent risk factor for prolapse recurrence (RR = 6.013 [2.965–12.193], P = 0.0001). The objective cure rate was higher in the laparoscopic sacral colpopexy group (93.7 vs. 68%, 193/206 vs. 70/103, P = 0.0001) with a highly reduced risk of recurrence (RR = 5.430 [1.660–17.765]). Median follow up was 22 months.ConclusionBoth techniques are safe, feasible, and effective. Laparoscopic sacral colpopexy remains the best choice in treatment of multicompartment and advanced pelvic organ prolapse while laparoscopic high uterosacral ligament suspension could be appropriate for moderate and isolated apical prolapse when laparoscopic sacral colpopexy is not suitable for the patient or to prevent prolapse in women at high risk at the time of the hysterectomy.

Recurrent ovarian endometrioma after conservative surgery

Objective: To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy. Methods: This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018. The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery. Nineteen factors were collected for risk evaluation. The prevalence of recurrent ovarian endometrioma and its 95% confident interval (CI) were calculated. Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence. Results: Recurrent ovarian endometrioma occurred in 33% (95% CI 27.7%-38.3%) patients. The median duration of follow-up was 36 months. during the median follow-up period of 36 months. Preoperative history of parity, preoperative infertility history, endometriosis surgery, moderate to severe dysmenorrhea, dyspareunia, intraoperative stage 4 according to revised American Society for Reproductive Medicine classification, presence of adenomyosis, and postoperative pain relief were associated factors based on univariate analysis. In contrast, infertility [odds ratio (OR) 2.22, 95% CI 1.14-4.33], moderate to severe dysmenorrhea (OR 2.13, 95% CI 1.09-4.15), and postoperative pelvic pain relief (OR 0.22, 95% CI 0.12-0.42) were independently associated factors based on multivariable logistic regression analysis. Conclusions: In our setting, preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk. In contrast, postoperative pain relief was significantly associated with lower recurrence risk.

P1111 - Is postoperative pelvic pain after robot-assisted radical prostatectomy associated with suture material used for sewing the anastomosis? A prospective randomized trial

P1111 - Is postoperative pelvic pain after robot-assisted radical prostatectomy associated with suture material used for sewing the anastomosis? A prospective randomized trial

Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis.

To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.

Reajuste de Sling TOT: ¿vale la pena?

Introducción: Desde su introducción, el sling TOT se instaló rápidamente como una opción segura y efectiva para el tratamiento de la incontinencia de orina de esfuerzo (IOE) femenina. Con el desarrollo del sling TOT reajustable, se adquirió la posibilidad de reacomodarlo si los resultados funcionales no hubieran sido óptimos (persistencia de IOE).&#x0D; Objetivos: Analizar los resultados globales de nuestra serie de casos en términos de éxito funcional y complicaciones postquirúrgicas; y analizar la relación entre el reajuste de sling y el desarrollo de obstrucción miccional postquirúrgica, erosión de prótesis, dolor pelviano e insatisfacción con astas de prótesis.&#x0D; Materiales y Métodos: Se realizó un análisis retrospectivo comparativo entre 2006 y 2016 de pacientes sometidas a colocación de sling TOT reajustable y se analizaron como subgrupo aquellas donde se hubiese realizado un reajuste de sling como segundo procedimiento. El análisis incluyó: presencia de reajuste de sling, erosión de malla, complicaciones relacionadas con astas de prótesis, desarrollo de obstrucción miccional postquirgica, y éxito funcional de la cirugía.&#x0D; Resultados: Fueron seleccionadas 70 pacientes a quienes se les colocó un sling TOT reajustable (curación de IOE 84.3%; obstrucción postquirúrgica 22.8%), a 11 (15.7%) de las cuales se les realizó reajuste de prótesis por resultados funcionales adversos en las cuales la tasa de curación de IOE ascendió a 92.8% y la tasa de obstrucción post reajuste al 28.5%.&#x0D; Se encontró una asociación significativa entre el reajuste y el desarrollo de dolor pelviano (36% vs 10%, p=0.02) y no existieron diferencias significativas entre los grupos en el desarrollo de obstrucción miccional postquirúrgica (p=0.23), erosión a vagina (p=0.78), erosión a vejiga (p=0.39) e insatisfacción con las astas de la prótesis (p=0.9).&#x0D; Conclusión: La posibilidad de elevar el éxito funcional de una primera cirugía en pocos minutos, con anestesia local, y sin diferencias significativas en la mayoría de las complicaciones analizadas, permiten colocar este procedimiento como un complemento útil para el tratamiento de la incontinencia de orina de esfuerzo, lo que no es posible con los slings convencionales.

Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women

To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse. Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction. Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ). Individual procedures or broad categories of procedures were compared: (1) vaginal versus abdominal routes for reconstruction, (2) abdominal procedures for reconstruction, (3) vaginal procedures for reconstruction, (4) hysterectomy and suspension versus hysteropexy for reconstruction, and (5) reconstructive versus obliterative options. The Urogynaecology Committee selected outcomes of interest: objective failure (obtained via validated pelvic organ prolapse [POP] quantification systems and defined as overall objective failure as well as failure rate by compartment); subjective failure (recurrence of bulge symptoms determined subjectively, with or without use of a validated questionnaire); reoperation for POP recurrence; complications of postoperative lower urinary tract symptoms (de novo or postoperative stress urinary incontinence; reoperation for persistent, recurrent, or de novo stress urinary incontinence; urge urinary incontinence; and voiding dysfunction); perioperatively recognized urinary tract injury (bladder or ureter); other complications (mesh exposure, defined as mesh being visible and exposed in the vagina, and non-sexual pelvic pain); and sexual function (de novo dyspareunia and sexual function score according to a validated questionnaire). This guideline will benefit patients seeking surgical correction of apical POP by improving counselling on surgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various surgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from 2002 to 2019. The search included multiple terms for apical POP surgical procedures, approaches, and complications. We excluded POP repairs using transvaginal mesh and studies that compared procedures without apical suspension. We included randomized controlled trials and prospective or retrospective comparative studies. We limited language of publication to English and French and accessibility to full text. A systematic review and meta-analysis was performed. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Gynaecologists, urologists, urogynaecologists, and other health care providers who assess, counsel, and care for women with POP. All statements refer to correction of apical vaginal prolapse in the short and medium term (up to 5 years), except when otherwise specified.

Post-operative clinical, manometric, and defecographic findings in patients undergoing unsuccessful STARR operation for obstructed defecation

To evaluate the reason for failure of STARR (stapled transanal rectal resection) operation for obstructed defecation. A retrospective study (June 2012-December 2017) was performed using a prospectively maintained database of patients who underwent STARR operation for ODS (obstructed defecation syndrome), complaining of persisting or de novo occurrence of pelvic floor dysfunctions. Postoperative St Mark's and ODS scores were evaluated. A VAS was used to score pelvic pain. Patients' satisfaction was estimated administering the CPGAS (clinical patient grading assessment scale) questionnaire. Objective evaluation was performed by dynamic proctography and anorectal manometry. Ninety patients (83.3% females) operated for ODS using STARR technique were evaluated. Median ODS score was 19 while 20 patients (22%) reported de novo fecal urgency and 4 patients a worsening of their preoperative fecal incontinence. Dynamic proctography performed in 54/90 patients showed a significant (> 3.0cm) rectocele in 19 patients, recto-rectal intussusception in 10 patients incomplete emptying in 24 patients. When compared with internal normal standards, anorectal manometry showed decreased rectal compliance and maximum tolerable volume in patients with urgency. Nine patients reported a persistent postoperative pelvic pain (median VAS score 6). Failure of STARR to treat ODS, documented by persisting ODS symptoms, fecal urgency, or chronic pelvic pain, is often justified by the persistence or de novo onset of alteration of the anorectal anatomy at defecation. This occurs in about half of the patients, but in 40% of the cases who complained of incomplete emptying or incontinence, anatomical abnormalities were not recognized.

Long-term outcome after surgical repair of pelvic organ prolapse with Elevate Prolapse Repair System

Female pelvic organ prolapse (POP) is a common condition and the correction of prolapse remains a major challenge for the surgical community. A retrospective study of women with POP undergoing pelvic reconstructive surgery with the Elevate System followed-up for 48 months. A total of 138 women with POP were included in the study. We observed an objective cure rate of 94.9% for the anterior wall after 4 years’ follow-up. The subjective cure rate was 97.1%. Improvement in the urinary symptoms was seen after the surgery: the number of asymptomatic patients increased from 14.5 to 77% after the 4 years of follow-up. We reported no cases of bleeding, haematoma, mesh infection and bowel injury, while we had four cases of bladder injury and one case of sepsis. The mesh extrusion rate was 7.3%, all cases interested the anterior compartment. Postoperative dyspareunia and pelvic pain were rare. In this cohort, the Elevate Prolapse Repair System was associated with excellent long-term results, for both anatomical corrections of prolapse, with a high objective and subjective cure rate and a functional urinary outcome.Impact statementWhat is already known on this subject? Female pelvic organ prolapse is a common condition and the correction of prolapse remains a major challenge for the surgical community. The optimal treatment of POP has still to be determined.What do the results of this study add? The findings from this study shows that the Elevate Prolapse Repair System had high anatomic results associated with a good durability, low morbidity and excellent subjective outcome. To the best of our knowledge, this is the first study that reports a follow-up up to 48 months.What are the implications of these findings for clinical practice and/or further research? The Elevate Prolapse Repair System was associated with excellent long terms results in terms of safety, durability and tolerability during the 4 years’ follow-up. Despite the fact that the Elevate kit produced by AMS was withdrawn from the market and it is no longer available, we believe that it is helpful to have data about the outcomes of a transvaginal mesh implant.

Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study.

Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery. The study aimed to assess pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis. The study involved prospectively collected data regarding pelvic pain and quality of life before and after surgery. It was conducted at a tertiary endometriosis referral unit at Aarhus University Hospital. A total of 175 women were included. Patients underwent laparoscopic bowel resection for endometriosis. Questionnaires for pain (Numerical Rating Scale) and quality of life (RAND Short Form-36) were answered before and 1 year after surgery. Data on analgesic and hormone treatment were collected. Preoperative and postoperative pelvic pain and quality-of-life scores were compared, and risk factors for improvement/worsening were identified. A total of 97.1% of the women completed the 1-year follow up. A significant decrease (p = 0.0001) was observed on all pelvic pain parameters. Most profound was the decrease in dyschezia. A significant improvement on all quality-of-life scores was observed (p = 0.0001). A surgical complication did not have a negative impact on outcome 1 year after surgery. The postoperative outcome was not related to the type of surgery. This is an observational study without a control group. Risk factor data should be interpreted with caution, because the study was relatively underpowered for some of the rare outcomes. A significant and clinically relevant improvement in pelvic pain and quality of life 1 year after laparoscopic bowel resection for endometriosis was found. We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment. See Video Abstract at http://links.lww.com/DCR/A472.

01: Minimally invasive sacrocolpopexy versus vaginal uterosacral ligament suspension: Comparing anatomic outcomes at 1 year

Our aim was to compare anatomic outcomes 1-year after surgery between patients who underwent minimally invasive sacrocolopopexy (MISC) (laparoscopic or robotic) with synthetic mesh to those who underwent vaginal uterosacral suspension (USLS) for management of apical prolapse. Secondary outcomes included comparing intra and postoperative complications. This was a multi-center, retrospective cohort study through the Fellows Pelvic Research Network. Patients with prolapse who underwent apical suspension with USLS or MISC from January 2013 to January 2016 with at least 1-year postoperative anatomic data were included. Patients with prior apical repairs, prior vaginal repair with biologic/synthetic graft, or history of connective tissue disorders were excluded. Eligible patients were identified using current procedural terminology codes. Relevant pre, intra, and postoperative data were abstracted from medical records. Prolapse recurrence beyond the hymen and/or POPQ stage 2 or higher were identified at 1-year postoperatively. Categorical data were compared using chi-square and Fisher’s exact tests, and continuous data were compared using the Wilcoxon rank sum test. During the study period, 311 patients underwent MISC (159 laparoscopic and 152 robotic) and 129 patients underwent USLS. They all had 1-year POPQ data available. The proportion of patients in MISC and USLS group were similar with respect to stage of prolapse (47.3% vs. 44.2% with stage 2 and 47.9% vs. 46.5% with stage 3). The median (interquartile range) preoperative apical point C was higher in the MISC group at -2.5 (-4.0, 1.0) than in the USLS group at 0.0 (-4.0, 2.5). The anterior and posterior walls were similar: Aa/Ba at 1.0 (0.0, 2.0) and Ap/Bp at -1.0 (-2.0, 0.0). Intra and perioperative complications such as blood loss (P < 0.0001), conversion to laparotomy (P = 0.002), urinary dysfunction (P = 0.02), and fever (P = 0.007) were higher in the USLS group, but operative time was longer in MISC group (P = 0.002). Three patients in the MISC group had mesh erosion and 5 patients in the USLS group had suture erosions. Postoperative pelvic pain, dyspareunia, voiding and bowel dysfunction were comparable in the two groups. At 1-year postoperatively, 50 patients (38.8%) in the USLS group had apical descent beyond the hymen compared to 77 (24.8%) patients in the MISC group (P = 0.003). Recurrence in the anterior compartment beyond the hymen was also higher in the USLS versus MISC group: 29 (22.5%) vs 19 (6.1%) patients (P < 0.0001), respectively. Posterior compartment recurrences were comparable: 5 (3.9%) versus 16 (5.1%) patients in the USLS versus MISC group (P = 0.57), respectively. At 1-year postoperatively, stage 2 prolapse or greater were noted in 69 (45.7%) patients in the USLS group versus 108 (34.7%) patients in the MISC group. While MISC had longer operative times and risk of mesh erosion, anterior and apical compartment prolapse recurrence rates were lower at 1 year compared to USLS. Future studies comparing bothersome bulge symptoms and need for repeat surgery or pessary placement are currently underway to better assess both symptomatic and anatomic failure within 1-year from initial prolapse surgery.

Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

Study ObjectiveOur aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation. DesignRetrospective study (Canadian Task Force classification II-2). SettingSingle university hospital. PatientsWomen who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence. InterventionsTelephone interviews to assess pain, sexual function, and general health. Measurements and Main ResultsPain was measured by the McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index (FSFI) for sexual health and dyspareunia. General health was assessed with the 12-item Short-Form Health Survey. Among 160 enrolled women, mean time since surgery was 20.8 ± 10.5 months, mean age was 62.1 ± 11.2 years, 93.8% were white, 86.3% were postmenopausal, and 3.1% were tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and perirectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least 1 year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p < .05). Current pelvic pain correlated with early postoperative pelvic pain (p < .001), fibromyalgia (p = .002), worse physical health (p = .003), and somatization (p = .003). Sexual function was suboptimal (mean FSFI, 16.2 ± 12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia. ConclusionOne in 6 women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early postoperative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.

Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis

Two surgical approaches usually are used in the surgical management of deep infiltrating endometriosis of the rectum: theradical approach that mainly is based on colorectal resection and the conservative or symptom-guided approach that prioritizes conservation of the rectum. There are no data available that compare long-term functional digestive outcomes of 1 approach to the other. The purpose of this study was to compare long-term digestive outcomes in women who were treated by either rectal shaving or colorectal resection for deep endometriosis infiltrating the rectum. A retrospective comparative study was performed. All women who were treated with surgery for deep endometriosis infiltrating the rectum by either shaving or colorectal resection at the University Hospital of Rouen from January 2005 to January 2010 were enrolled. Follow-up evaluation was carried out fora minimum of 5 years. Postoperative evaluation of digestive symptoms was performed by 4 standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott-Symptom score for constipation, the Wexner score for anal continence, and the Bristol Stool Score. Symptoms that were related to endometriosis, fertility, and disease recurrence were obtained from a specific questionnaire. A total of 77 women were included. Three women were lost to follow up (3.9%), and 3 were treated by disc excision (3.9%). The mean follow-up time was 80±19 months. Forty-six women underwent conservative rectal shaving, and 25 women underwent colorectal resection. Patient characteristics and the severity of the disease were comparable in both groups. Patients who were treated by rectal shaving had significantly better Gastrointestinal Quality of Life Index values, lower Knowles-Eccersley-Scott-Symptom scores for postoperative constipation, and better anal continence. No statistically significant differences were revealed for postoperative pelvic pain. Rectal recurrence occurred in 8.7% of patients who were treated by conservative surgery: 4.3% underwent secondary colorectal resection and 4.3% were treated secondarily by rectal shaving. Consequently, avoiding a recurrence for merely 1 patient would have required 11 patients to undergo colorectal resection instead of shaving. Our data suggest that, in patients who are treated for rectal endometriosis, colorectal resection does not improve long-term postoperative functional outcomes when compared with rectal shaving.

Colpopexy and Pelvic Pain [11Q

INTRODUCTION: To examine the relationships between different colpopexy approaches and pre-operative and post-operative pelvic pain. METHODS: We extracted and analyzed data from Clinformatics™ DataMart (CDM) which is large national commercial insurance database. Using a retrospective cohort approach, data was collected from 9,180 patients between the ages of 18–64 who underwent colpopexy between 2005 and 2012. Cases were selected using ICD-9 and CPT codes. Logistic regression analysis was performed using SAS software. Data were analyzed to determine relationships between pre-operative and post-operative pain, pain and concomitant hysterectomy and pelvic floor repairs, and pelvic pain and surgical approach. RESULTS: A total of 18,092 patients underwent colpopexy between January 2005 and May 2012. Of which, 9,180 met criteria and data from these cases was analyzed. Younger patients were more likely to have pre-operative pain. Vaginal colpopexy was associated with more postoperative pain compared to abdominal (OR 1.53, 95% CI 1.08–2.18). Concomitant hysterectomy was associated with less postoperative pain (OR 0.54, 95% CI 0.36–0.8). Concomitant vaginal repair were associated with more postoperative pain for those without prior pain (OR 1.85, 95% CI 1.21–2.83). CONCLUSION: Patients with pre-operative pain were more likely to undergo an abdominal colpopexy, have a concomitant hysterectomy, and have post-operative pain. Concomitant hysterectomy was associated with less pain, while concomitant vaginal repairs had no significant impact on post-operative pain. Randomized controlled trials are warranted. These findings will have significant impact on pre-operative patient counseling on surgery route.

Electrocoagulación tubárica monopolar con sección y remoción como método de esterilización quirúrgica permanente

OBJETIVO: Determinar las ventajas de la electrocoagulación tubárica monopolar (ETM) como método de esterilización quirúrgica (EQ) permanente. MATERIAL Y MÉTODOS: Estudio de 141 pacientes que acudieron a la consulta de planificación famiíiar de la Clínica Maternidad Santa Ana, Instituto Venezolano de los Seguros Sociales, durante el periodo abril 2003-agosto 2004, en solicitud de que le fuera practicado un método de EQ permanente voluntaria. Fueron agrupadas aleatoriamente en dos grupos, uno experimental de 71 pacientes (50,4%), a quienes se le practicó EQ permanente voluntaria por técnica de ETM con sección remoción (ETMSR) y otro de 70 pacientes (49,6%) a quienes se le practicó EQ permanente voluntaria por las técnicas clásicas. RESULTADOS: La edad promedio fue 32 ±6 años, con 67,4% entre 28 y 39 años. No hubo diferencia significativa en el número de gestas (media de 4±2,3). La técnica de EQ experimental fue utilizada en todas las mujeres del primer grupo y, en el grupo control Pomeroy 41,1%, Madlener 22,9%, Parkland 15,7%, Kroener 10% y Uchida 4,3%. El 95% de las pacientes permaneció hospilalizada (media de 2 ± 0,5 días). Hubo diferencias significativas p&lt;0,05 entre los grupos de estudio respecto al dolor pélvico -2,8% grupo experimental y 12,9% grupo control-, al igual que en las relaciones sexuales sin temor al embarazo, con 7,0% y 17,1%, respectivamente. En el estudio de costo se notó un ahorro de US$ 102,08 a favor de la técnica experimental. CONCLUSIÓN: La técnica de ETMSR mostró menos dolor pélvico postoperatorio, menor temor al embarazo en las relaciones sexuales y menor costo, que las técnicas clásicos de esterilización.

Thermal balloon ablation versus transcervical endometrial resection: evaluation of postoperative pelvic pain in women treated for dysfunctional uterine bleeding

Purpose of the study: To evaluate postoperative pain after mini-invasive surgical treatment for dysfunctional uterine bleeding (DUB) with transcervical endometrial resection or thermal ablation balloon. Materials and Methods: A longitudinal observational study, analyzing 47 women affected by DUB who underwent endometrial ablation was conducted. The authors collected evaluation of pelvic pain at one and four hours after intervention and the individual necessity of analgesics. After 30 days, all patients underwent a gynecological visit to evaluate postoperative outcome. Results: Pelvic pain was higher one and four hours after procedure in thermal balloon ablation group, and patients in the same group required more analgesic rescue dose. There were no complications such as uterine perforation, heavy blood loss or thermal injuries with both the procedures. Conclusion: Thermal balloon ablation appears a more painful procedure than endometrial resection, both in the immediate postsurgical time and 30 days after surgery. Ad hoc anaesthesiologic and analgesic protocol should be adopted to ensure quick recovery and good acceptance of the procedure.

The Role of Ovarian Suspension in Endometriosis Surgery: A Randomized Controlled Trial

Study ObjectiveA very high percentage of patients with severe pelvic endometriosis develop adhesions after laparoscopic surgery. The objective of this trial was to evaluate the role of ovarian suspension performed during surgery for severe endometriosis on ovarian adhesions and postoperative pelvic pain. DesignA randomized controlled trial (Canadian Task Force classification I). SettingThe tertiary care University Hospital of Bologna, Bologna, Italy. PatientsEighty patients with ovarian and posterior deep infiltrating endometriosis were included in the study. InterventionsPatients underwent laparoscopic surgery for endometriosis and were randomized sequentially into 2 groups: transient ovarian suspension was performed in the treatment group (n = 40), whereas in the control group (n = 40) ovaries were left free in the pelvis. Symptom intensity (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) were ranked using a visual analog scale. Postsurgical ovarian adhesions were evaluated using transvaginal ultrasonographic scans performed by an ultrasound operator who was blinded to the details of the operative procedure and women's randomization allocation. Complications, lesion localization, endometrioma diameter, and surgery time were recorded. Measurements and Main ResultsAt follow-up, a significantly lower rate of ultrasound-detectable ovarian adhesions with the uterus and the bowel was observed in the treatment group, respectively (46.7% vs 77.3%, p = .003 and 26.7% vs 68.2%, p < .0005). Patients in the control group showed a higher percentage of fixed ovaries with moderate and severe adhesions than the treatment group, respectively (56.8% vs 28.9%, p = .003 and 20.5% vs 8.9%, p = .110). No differences between the 2 groups were found regarding complications and pelvic pain. ConclusionOvarian suspension seems to be an additional effective surgical procedure associated with an increased ovarian mobility in women treated for severe endometriosis. Moreover, it is feasible, safe, simple, and fast. Hence, it should be routinely used during laparoscopic surgery for endometriosis.

Prise en charge thérapeutique des douleurs pelvipérinéales chroniques postopératoires d’origines nerveuses somatiques pariétales

All surgical procedures require an incision with a risk of nerve damage at the site of the scar or as a result of fibrotic scar tissue. The purpose of this article is to describe the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage. A comprehensive review of the literature was performed by searching PUBMED for articles on the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage. Postoperative lesions of parietal somatic nerves (ilioinguinal, iliohypogastric, genitofemoral, pudendal, obturator, femoral) are frequent after pelvic surgery. Clinical examination of the scars (trigger zone) and detailed analysis of the topography and type of pain are essential elements in the analysis of this pain. Infiltration of local anaesthetic at the trigger point or along the nerve has a diagnostic value. Corticosteroid infiltrations and minimally invasive treatments such as pulsed radiofrequency have provided more or less lasting improvement of the symptoms. Surgical nerve release together with resection of fibrosis and removal of prosthetic material provides good long-term results. The surgical approach depends on the nerve concerned and the level of the lesion. The management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage is based on local infiltration of anaesthetics and corticosteroids. Nerve release surgery with resection of fibrosis provides the best long-term results.