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Human Reproduction, Vol. 10, No. 11, pp. 2895-2901, 1995
© 1995 European Society of Human Reproduction and Embryology

research-article

An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for chronic pelvic pain

Harry G. Saravelos1, Tin-Chiu Li and Ian D. Cooke

Department of Obstetrics and Gynaecology, Jessop Hospital for Women Leavygreave Road, Sheffield S3 7RE, UK

Correspondence: 1 To whom correspondence should be addressed at the Biomedical Research Unit, Jessop Hospital for Women, Leavygreave Road, Sheffield, S3 7RE, UK

We evaluated the outcome of microsurgical (n = 72) and laparoscopic (n = 51) adhesiolysis in women who complained of chronic pelvic pain. Adhesion severity was not significantly different between the two treatment groups. The influences of the following variables on the outcome of all 123 cases of adhesiolysis were examined: (i) surgical modality (microsurgical or laparoscopic), (ii) history of infertility, (iii) associated dyspareunia and (iv) aetiological factors of adhesive disease (endometriosis, pelvic inflammatory disease and previous laparotomy). Toadjust for differences in follow-up intervals, overall and subgroup cumulative rates of pain persistence/recurrence were calculated and compared. To adjust for interrelationships between variables and to correct for differences between the treatment groups, a proportional hazards regression analysis was employed. This analysis showed that the cumulative rate of pain persistence/recurrence at 24 months was not significantly different after microsurgical (44%) and laparoscopic (53%) adhesiolysis. From all the variables which were examined, the only one which appeared to influence the impact of surgical adhesiolysis for chronic pelvic pain was a history of previous laparotomy. A history of previous laparotomy was associated with approximately three times higher rates of pain persistence or recurrence. This effect did not depend on whether previous laparotomy was carried out for pain or for other indications. The most likely explanation for the failure of these patients who had a previous laparotomy to respond to surgery is that they intrinsically have a higher rate of adhesion formation and reformation. This can only be confirmed with a prospective study where all patients will undergo a second-look laparoscopy.

Key words: chronic pelvic pain/laparoscopic adhesiolysis/microsurgical adhesiolysis


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