Laparoscopy on Account of Chronic Pelvic Pain: a RetrospectiveClinical Study

Overview

Objectives:
To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). Toverify the possible predictive value of the anamnestic factors for the laparoscopically establisheddiagnosis.Design: A retrospective clinical trial.Setting: Department of Obstetrics and Gynaecology, lst Faculty of Medicine and the GeneralFaculty Hospital, Charles University, Prague.Methods: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in thelast 5 years. With the help of statistical analysis (c2) the possible influence of age, previoussurgical intervention, history of PID, dysmenorrhea, infertility, and some other factors on endoscopic finding was verified.Results: 480 laparoscopies for CPP were performed from the year 1995 to 1999. The most frequentfindings were adhesions (22.3%), endometriosis (20.4%), PID (17.7%), and normal finding (17.7%).In 53% of all cases the operative laparoscopic procedure was done, most frequently the adhesiolysis (62.2%). Only one serious complication during laparoscopy was recorded (0.21%).In women younger than 30 years endometriosis was the most frequent finding (22.8%), in womenolder than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between thegroups was statistically significant (P < 0.0001). In patients with previous operation in pelvis theadhesions were found most frequently (46.2%). Diversity of findings in women with and withoutprevious operation was also significant (P < 0.0001). In women treated for PID, pelvic inflammation was found in 25.8%, but in 22.5% the finding was negative and in 20.2% the endometriosis wasdiagnosed. In these subgroups (women after and without treatment of PID) the diversity of findings was not significant (P < 0.1). In infertile women, suffering from CPP, PID was found mostfrequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients withdysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominantfinding (30.4%, resp. 29.1 %).Conclusion: Laparoscopy for CPP is a safe and effective method for verifying and adequate therapy of as yet hidden pathological findings. With the help of anamnestic factors some laparoscopicfindings are predictible; although the sensitivity and specificity is very poor.

Key words:
chronic pelvic pain, laparoscopy, laparoscopic finding prediction