Laparoscopic adhesiolysis and relief of chronic pelvic pain (original) (raw)
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Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis
Gynecological Surgery, 2004
There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We performed a long-term review of women after laparoscopic adhesiolysis over the past 4 years. Patients were excluded from the study if they had additional pathology such as endometriosis or required additional procedures other than adhesiolysis. Umbilical insertion of Verress' needle and primary trocar was used except when the patient had had a previous midline laparotomy, in which case Palmer's point was used for entry. Adhesions were divided using Metzenbaum scissors with haemostasis using suction irrigation achieved with a Surgiflex R Wave suction irrigation system with BICAP bipolar diathermy probe (ACMI, USA). Hydroflotation with heparinised saline or 4% icodextrin was used to reduce adhesion recurrence. Patients were sent a postal questionnaire and contacted by telephone. Visual analogue scales were used to record pain scores for dysmenorrhoea (in those women who still had a uterus), dyspareunia, dyschezia and chronic daily pain. An EQ-5D questionnaire was also enclosed to assess quality of life. One hundred and forty-three procedures were identified between September 1998 and July 2002. Having excluded those with additional pathology that required treatment, 90 were eligible for the study. Seventy-six replies were obtained; seven patients had moved away. Sixty-nine replies were analysed. Fifty-one (74%) reported some improvement in their symptoms [12 (17%) pain completely gone, 26 (38%) greatly improved, 13 (19%) a little better]. Patients still had significant pain [scores out of 100 for dysmenorrhoea (45), dyspareunia (28), dyschezia (28) and daily pain (29)]. Overall, quality of life was still lower than national averages (self-rated health status mean =67.0 vs. 82.34, P< 0.05, weighted health state index =0.67 vs. 0.85, P< 0.05), except in the good responders (pain gone or greatly improved, for whom quality of life returned to normal). There was no difference in pain scores, response and quality of life between women who had had their surgery more than 24 months earlier and those who had had surgery more recently. We have found a good response to adhesiolysis, which is comparable with other studies. A good response is associated with a normal quality of life and appears to be long standing.
2013
To evaluate the occurrence and intensity of cyclic pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy and to explore the effect of the procedure on pelvic pain relief in women with perioperative detection of endometriosis and in women with histologic confirmation of adenomyosis. Design: Prospective observational study with 12-month follow-up after laparoscopic supracervical hysterectomy (Canadian Task Force classification II-2). Setting: University teaching hospital in Norway. Patients: One hundred thirteen premenopausal women with preoperative cyclic pelvic pain treated via laparoscopic supracervical hysterectomy. Interventions: Study participants underwent laparoscopic supracervical hysterectomy and were followed up at the outpatient clinic at 12 months after the procedure. Measurements and Main Results: The main outcomes were occurrence, intensity, and reduction of cyclic pelvic pain and patient satisfaction measured using an ordinal and a visual analog scale at 12 months after the procedure. Of the 113 women included in the study, 8 were lost to follow-up. Consequently, 105 women (92.9%) were followed up at 12 months after surgery. All women had cyclic pelvic pain preoperatively, but only 34 (32.4%) experienced this pain at 12 months after the procedure. The intensity of pelvic pain was reduced from a mean (SD) of 5.5 (2.4) preoperatively to 0.7 (1.5) at 12 months after the procedure on a visual analog scale of 0 to 10 (p , .01). Endometriosis was diagnosed perioperatively in 14 women (12.4 %), and adenomyosis was confirmed at histologic analysis in 19 (18.1%). In women with perioperative detection of endometriosis or histologic confirmation of adenomyosis, there were no significant differences in main outcomes at 12 months after laparoscopic supracervical hysterectomy when compared with women without these diagnoses. Conclusion: Laparoscopic supracervical hysterectomy is associated with high patient satisfaction and reduces cyclic pelvic pain to a minimum by 12 months after the procedure.
Comparison of Laparoscopic and Abdominal Methods of Hysterectomy from Patient’s Perspective
Medical Science and Discovery, 2015
The aim of this study was to compare the postoperative pain and satisfaction of patients who underwent total laparoscopic or abdominal hysterectomy for benign gynecologic conditions. Materials and Methods: This study was a prospective, randomized trial. A visual analogue scale and patient satisfaction score scale were used to evaluate the patients' postoperative satisfaction rates. Seventy-one patients who underwent total laparoscopic hysterectomy were compared with 68 patients who underwent total abdominal hysterectomy for benign gynecologic indications. Results: The groups were similar with respect to age, race, gravidity and parity status, and uterine weight. Hospital stay; need for analgesic use; visual analogue scale pain scores at 12, 24, and 36 hours; patient satisfaction scores at 24 and 48 hours and one week; and blood loss were statistically lower in the laparoscopic hysterectomy group than in the abdominal hysterectomy group (p<0.001). Conclusion: Laparoscopic hysterectomy was superior to abdominal hysterectomy in terms of short-term followup, postoperative pain, and satisfaction with the operation scar.
Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy
Journal of Minimally Invasive Gynecology, 2007
STUDY OBJECTIVE: To assess the incidence of urinary incontinence, bowel dysfunction, and sexual problems after laparoscopic hysterectomy as compared with abdominal hysterectomy. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in the Netherlands, experienced in gynecologic minimal access surgery.
Long-Term Outcomes Following Laparoscopic Supracervical Hysterectomy
Obstetrical & Gynecological Survey, 2009
It is unclear whether the risk of persistent vaginal bleeding and pelvic pain following surgery is increased following laparoscopic supracervical hysterectomy (LSH) compared to total laparoscopic hysterectomy (TLH). In Norwegian women who underwent LSH, this retrospective study evaluated the occurrence of vaginal bleeding and pelvic pain, the toleration of residual symptoms, and overall satisfaction with the procedure through the use of a postal questionnaire during 2004 and 2005. Of a total of 315 consecutive patients contacted 12 to 36 months after surgery, 240 (78%) responded. Menstrual bleeding continued in 24% (57 women) but was considered minimal in 90% of the women; on a 10-point visual analogue scale (VAS), the mean bothersome score was 1.1 (SD 2.0). When only regular bleeding was included in the analysis, the percentage decreased from 24% to 8%. Women with a less experienced surgeon were more likely to report continued vaginal bleeding (P Ͻ 0.02). Of the 178 women (74%) with menstrual pain before LSH, up to 3 years after surgery, 89 women (38%) reported continued menstrual/cyclical pain. However, the pain was considerably less intense; the mean VAS-10 score before and after surgery was 6.8 (SD 2.05) and 3.5 (SD 2.16), respectively (P Ͻ 0.01). Significantly higher levels of residual menstrual/cyclical pain after surgery occurred among women reporting endometriosis as a reason for the hysterectomy compared with women who did not (P Ͻ 0.001). A total of 90% of the women were very satisfied (70%) or satisfied (20%) with the hysterectomy. These findings show a high level of patient satisfaction with LSH despite the relatively common occurrence of residual menstrual bleeding and pain.
Laparoscopic adhesiolysis in patients with chronic abdominal pain
Current Opinion in Obstetrics and Gynecology, 2004
Purpose of review The purpose of this review was to evaluate the indications, safety, and efficacy of laparoscopic adhesiolysis and its prevention in patients with chronic abdominal pain. Recent findings The safety of laparoscopic adhesiolysis can be improved by using an optic trocar for laparoscopy, by using an ultrasonic technique for adhesiolysis, and by taking care with regard to risk factors. Although many studies have reported pain reduction after laparoscopic adhesiolysis, a recent randomized study showed no more pain relief than with diagnostic laparoscopy alone. The regrowth of adhesions after adhesiolysis is less after the laparoscopic technique compared with open surgery. Liquid products can prevent the formation of adhesions, but their clinical efficacy has not yet been proved in randomized studies in humans. Summary Older patients with a greater number of previous abdominal operations are more prone to complications in laparoscopic surgery. The introduction of a Veress needle into the ninth intercostal space, the use of an optic trocar and ultrasonic dissection can reduce the incidence of iatrogenic bowel perforations. For chronic pain, diagnostic laparoscopy is encouraged, but laparoscopic adhesiolysis is no longer recommended; its benefit being no greater than that of diagnostic laparoscopy alone.
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2011
Abdominal pains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominal pain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominal pain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as "phantom pain" following amputation, which takes time to resolve after this type of surgery.
American Journal of Obstetrics and Gynecology, 2010
To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease. STUDY DESIGN: A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume Յ14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra-and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia.
Long-Term Outcomes Following Laparoscopic and Abdominal Supracervical Hysterectomies
Obstetrics and Gynecology International, 2010
Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.
The Journal of the American Association of …, 1994
We compared laparoscopic-assisted vaginal hysterectomy (LA VH) with total abdominal hysterectomy (TAH) in a case control study that evaluated length of operation, blood loss, length of hospital stay, drug requirements for pain, and postoperative pain and activity levels. Of 81 women who underwent nonradical hysterectomy for a primary diagnosis of pelvic pain between June 1 and December 31, 1992, 19 who underwent each procedure were chosen for inclusion in the study. Patients were matched in a case control manner for age, weight, diagnosis, and uterine weight. All 38 hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were performed. The average surgery time for LA VH was 144 minutes and for TAH 98 minutes, a significant difference (p <0.005). There were no significant differences between estimated blood loss and change in hemoglobin from preoperative levels to postoperative day 1 levels between the groups. Women having TAH reported significantly more pain after their release from the hospital. There was no significant difference in pain during hospitalization apparently because patients who had TAH self-medicated to maintain acceptable levels. That group in fact used an average of 436 mg meperidine during their hospital stay, significantly more than the 197 mg used by the LA VH group (p <0.005). The length of stay was 2. 125 days for LA VH and 3.542 days for TAH (p <0.001). On a scale of 1 to 10 (10 being complete normal activity) the activity level of women undergoing LAVH was 9.2 by day 14 compared with 6.4 for those having TAH (p <0.005). By the sixth postoperative week the latter group reported an activity level of only 8.5, indicating that the ability to function is much more severely limited after TAH than LA VH.