Primary chronic pelvic pain: laparoscopic fulguration of uterosacral ligaments vs. Observation only Hospital de San José, Bogotá DC. march 2008 to april 2010
Dolor pélvico crónico primario: fulguración laparoscópica de los ligamentos úterosacros vs. observación hospital de san José, Bogotá DC. marzo 2008 a abril 2010
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Chronic pelvic pain (CPP) requires an adequate diagnosis and treatment. Surgical therapeutic options (ablation, fulguration of uterosacral ligaments and presacral neurectomy) as well as pharmacological treatments exist. Objective: we sought to compare the level of CPP of unknown etiology treated with laparoscopic fulguration of uterosacral ligaments with observation only, at Hospital de San José, Bogotá DC. Materials and Methods: a prospective cohort study by meaos of a pre-surgical visual analogous scale and follow-up at one, two and six month intervals after the laparoscopy was conducted between March 2008 and April 2010. Results: 69 patients were included, 28 in the fulguration group and 41 in the observation group. There were no intraoperative complications. The media of the pre-surgical Friedman test in the fulguration group was 8 (RIC:6-8) and the media of pelvic pain at six months was 3 (RIC:2-6) with a p-value of 0.001, showing statistic significance in pain improvement over time. The Mann-Whitney Wilcoxon test was used to assess differences between groups at six months obtaining a p-value of0.66, thus no difference between the media of pain in the two groups was observed. Conclusions: there is no significant difference on the improvement of pain between the two groups. Better results may be offered through longer follow-up periods and other surgical techniques.
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1. Alba M. Nerve pathways surgical interruption for chronic pelvic pain. Rev Colom Obstet y Ginecol. 2003 Jan.-mar; .54(1): 33-40.
2. Howard FM. Chronic pelvic pain. Obstet Gynecol. 2003 Mar;101(3):594-611.
3. Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption ofpelvicnetve pathways forprimaryandsecondary dysmenon-hoea. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001896.
4. Stones RW, Mountfield J. lnterventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev. 2000;(4):CD000387. Review.
5. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality oflife, and economic correlates. Obste/ Gynecol. 1996, 87:321-27.
6. Davies L, Ganger K, Drummond M, Saunders D, Beard R. The economic burdenofintractablegynaecologicalpain. JObste/ Gynecol. 1992, 12:46-54.
Criollo, C. Características ginecológicas y psicosociales del dolor pélvico crónico. Rev Colom Obstet y Ginecol. 2004 abr. jun; 55(2): 129-35.
8. Gunter J. Chronic pelvic pain: an integrated approach to diagnosis and treatment. Obstet Gynecol Surv. 2003 Sep;58 (9):615-23.
9. Dawood MY. Primary dysmenorrhea advances in pathogenesis and management. Obstet Gynecol. 2006 Aug; 108(2):428-41.
10. Escobar D. Neurectomía presacra por laparoscopia. Rev. chil. obstet. ginecol. 2003; 68(2): 87-92.
11. Zullo F, Palomba S, Zupi E, Russo T, Morelli M, Cappiello F, Mastrantonio P. Effectiveness ofpresacralneurectomy in women withsevere dysmenorrhea caused by endometriosis who were treated with laparoscopic conservative surgery: a 1-year prospective, randomized, double-blind, controlledtria!.Am J Obste! Gynecol. 2003 Ju!; 189(1):5-1O.
12. Buller JL,Thompson JR, CundiffGW, et a!. Uterosacral ligament: description ofanatomic relationships to optimize surgical safety. Obstet Gynecol. 2001 Jun;97(6):873-9.
13. Fuji, M. lnvestigation ofthe localization ofnerves in the uterosacral ligament: Detem1ination of the optima! site for uterosacral nerve ablation. Gynecol Obste! lnvest 2002; 54 (suppl): 11-17.
14. Latthe PM, Braunholtz DA, Hills RK. Measurement of beliefs about effectiveness oflaparoscopic uterosacral nerve ablation. BJOG. 2005 Feb; 112(2):243-6.
15. Chi-Mou, J. Treatrnent ofprimary deep dispareuniawith laparoscopic uterosacral nerve ablation procedure: a pilot study. J Chin MedAssoc. 2006; 69(3):110-14.
16. Butrick CW. Chronic pelvic pain: bow many surgeries are enougb? Clin Obste! Gynecol. 2007 Jun; 50(2):412-24.
17. Reiter RC. Evidence-basedmanagement ofchronicpelvicpain. Clin Obstet Gynecol. 1998 Jun;41(2):422-35.
18. Daniels J, Gray R, Hills RK, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled tria!. JAMA. 2009 Sep 2;302(9):955-61.
19. Latthe PM, Braunholtz DA, Hills RK. Measurement of beliefs about effectiveness oflaparoscopic uterosacral nerve ablation. BJOG. 2005 Feb; 112(2):243-6.
20. Latthe PM, Powell RJ, Daniels J, et a!. Variation in practice oflaparoscopic uterosacralnerve ablation: a Europeansurvey. J Obstet Gynaecol. 2004Aug; 24(5):547-51.
21. Xiong T, Daniels J, Middleton L, et al. Meta-analysis using individual patient data from randomised trials to assess the effectiveness oflaparoscopic uterosacral nerve ablation in the treatrnent ofchronic pelvis pain: a proponed protocol. BJOG. 2007 Dec; 114(12):1580, e 1-7.
22. Jacobson TZ, Duffy JM, Barlow D, et al. Laparoscopic surgery for pelvic pain associated with endometriosis. CochraneDatabase Syst Rev. 2009 Oct 7;(4):CD00l 300.
23. Monton, C. Escalas de ansiedad y depresión de Goldberg: una guía de entrevistaeficazpara la detección del malestar psíquico.AtenPrimaria.1993; 12 (6): 345-60.
24. Latthe P, Latthe M, Say L, Gülmezoglu M, Khan KS. WHO systematic review ofprevalence ofchronic pelvic pain: a neglectedreproductive health morbidity. BMC Public Health. 2006 Jul 6;6:177.
25. Santosh A, Liaquat HB, Fatima N, Liaquat S, Anwar MA. Chronic pelvic pain: a dilemma. J Pak MedAssoc. 2010 Apr; 60(4):257-60.
26. Johnson NP, Farquhar CM, Crossley, et al. A double-blind randomised controlled tria! oflaparoscopic uterine nerve ablation forwomen with chronic pelvie pain. BJOG. 2004 Sep;111(9):950-9.