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J Minim Access Surg. 2005 Sep;1(3):116-20. doi: 10.4103/0972-9941.18995.

Role of laparoscopy in evaluation of chronic pelvic pain.

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1
Department of O & G, Kasturba Medical College, Manipal.

Abstract

INTRODUCTION:

Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination.

SETTINGS AND DESIGN:

A retrospective study of patients who underwent diagnostic laparoscopy for CPP.

MATERIALS AND METHODS:

The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available.

STATISTICAL ANALYSIS USED:

McNemar Chi-square test for frequencies in a 2 × 2 table.

RESULTS:

The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women.

CONCLUSION:

The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control.

KEYWORDS:

chronic pelvic pain; endometriosis; laparoscopy; pelvic adhesions

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