Laparoscopy in the management of isolated chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is a frequent reason for gynecological consultation. They are all chronic pain symptoms, mainly felt in the lower abdomen. They may be cyclic or non-cyclic leading to a functional instability of the patient. This pain syndrome is problematic by its persistence and chronicity and resistance to conventional therapies which makes it increasingly resented by the patient and can even have pejorative consequences on it's psychology. The aim of our study was to evaluate the role of laparoscopy in the treatment of isolated chronic pelvic pain. Materials and methods: This is a retrospective study, spanning a period of 4 years from 2011 to 2015 about all patients explored for isolated chronic pelvic pain, at the department “C” of maternity center of maternity and neonatology and who have been practiced laparoscopy. Inclusion criteria: Nulligeste any patient whose age was between 15 and 30 years who consulted for CPP in whom clinical examination and various additional tests (ultrasound and biology) did not show an abnormality that could explain these pains. Exclusion criteria: Patients presenting for infertility or in whom a pelvic mass was discovered; and any pregnant patient. For each patient we collected clinical, ultrasound, laparoscopy the findings and possible treatment modalities and their results. Results: During the 4 years of the study, 30 laparoscopy were performed for isolated CPP or 2.72% of all laparoscopy made during this period. The average age of patients was 23.4 years [range, 15–30 years]. Among the 30 patients studied, 19 were virgin and 11 in sexual activity; they were all nulligeste. Background: 23 patients or 76.6% had no significant pathological antecedent. 5 patients (16.6%) already had an appendectomy and it was also the antecedent most frequently found. Clinical findings: Other associated functional signs were dominated by digestive disorders like abdominal bloating and constipation and this in 13.6% of cases. Others had urinary problems in 3% of cases, and the rest were bleeding in 1.5% of patients, menorrhagia in a patient, vaginal discharge and dyspareunia patients for 2 patients.18 patients had no associated signs. The duration of pain was estimated at 6 months in 46% of cases; 1 year in 42% of cases and 2 years in 12% of cases. The intensity was considered moderate by most patients is at 42.2% of the series; it was kind of gravity at 22.7% and was 39.3% in poorly defined. As for the periodic report by the menstrual cycle had 6 cases of secondary dysmenorrhea. Data of physical examination: The general examination had eliminated acute complications with effects on the general condition and eliminated the extra genital causes including bone or joint rheumatology. Abdominal examination did not reveal any peculiarities and had no abdominal tenderness in 100% of cases. The gynecological examination did not detect any abnormality in 71.2% of cases. Additional tests: All patients had received blood count formula. Urine culture and vaginal swab were requested before the call signs; laboratory abnormalities that were found are: anemia in 14 patients; leukocytosis in 2 patients, the urine culture performed were negative and 5 vaginal prelevements swabs were positive for Candida albicans. All patients underwent a pelvic ultrasound; thereof were normal in all cases (inclusion criteria) Results of laparoscopic exploration: Diagnostic laparoscopy enabled to highlight a condition in 76.66%. The lesions detected were dominated by endometriosis in 33.3% of cases. Pelvic inflammatory disease sequelae were found in 13.3% of cases. In 23 cases there was a discrepancy between ultrasound and laparoscopy, ultrasound was normal when we had an anomaly. In 7 cases there were no abnormalities or ultrasound or the laparoscopic exploration. Total diagnosed pathologies and were the cause of CPP were in order of frequency: Endometriosis: In 33.3%, the majority were in an advanced stage III or IV and were in 81.2% of cases disabling dysmenorrhea, we had made a release adhesions associated with electro coagulation of endometriosis lesions, cystectomy intraperitoneal for endometriomas and pathological examination. Sequelae of pelvic inflammatory disease: 13.3%. 3 patients had noted a serous effusion, Fitz Hugh and Curtis syndrome in one case, adhesiolysis was performed in 4 patients. No salpingectomy has been made in these young nulligestes women. Adhesions: 10% of cases in patients with a scarred abdomen and had conducted adhesiolysis. Ovarian cysts: In 3.3%, and it was a dermoid cyst. Polycystic ovaries: 3.3%. Postoperative: The average hospital stay was 1.03 days, we had noted no complications during surgery and the postoperative course was uneventful. Patients who had endometriosis were placed under contraceptive for at least 3 months; those who had pelvic inflammatory disease sequelae were put under antibiotics, NSAIDs were command for pelvic adhesions and progestins for ovarian dystrophies. Long-term evolution: The evolution was marked by improvement of symptoms in 86% of patients had pathology at laparoscopy. The pain had persisted in 3 patients that had nothing to laparoscopy and they had a particular psychological profile; the other 4 had improved in sharp suggesting a placebo effect of laparoscopy. 78% of patients who had endometriosis kept a small cyclical discomfort but improved significantly compared to the symptomatology of the first consultation before laparoscopy. Conclusions: After this work, we can conclude that the routine use of laparoscopy in front isolated CPP is profitable because in 76.6% of our series we found an etiology and almost 70% in the patients were relieved and much less embarrassed. This is also found in the literature but with different percentages. The causes are many, the role of laparoscopy is important in the diagnosis when all the additional tests came back negative but also laparoscopy has a role to process and establish a prognosis and this in the same operation.