Laparoscopic management of neural pelvic pain in women secondary to pelvic surgery

Objective To report the impact of the laparoscopic approach to the pelvic nerves in the management of neural pelvic pain in women secondary to pelvic surgery. Design Clinical prospective study. Setting Department of Gynecology and Obstetrics, St. Elisabeth Hospital, Cologne/Germany. Patient(s) One hundred twenty consecutive patients with pelvic neural pain after failure of all previous surgical and medical treatments. Intervention(s) Control of visceral pelvic pain was based on the LION procedure to the superior hypogastric plexus for permanent neuromodulation while pelvic somatic pain were primarily managed by laparoscopic nerve decompression. Main Outcome Measure(s) Comparison pre- and postoperatively of the pain situation with the visual analogue scale (VAS score) and consumption of analgesics. Result(s) Significant improvement was obtained in 65.5% of the patients with pelvic somatic pain (n = 113), whereas in seven patients with visceral pelvic pain, four of them reported on a significant reduction in the symptoms after neuromodulation of the superior hypogastric plexus. Conclusion(s) Laparoscopy is a unique method for diagnosis and therapeutic management of surgically damaged nerves and must be considered as a first-line option in the treatment of pelvic somatic pain, whereas in regard to the management of pelvic visceral pain, medical treatment remains first-line treatment.