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Chapter 7 - Evidence for Surgery for Pelvic Pain

Published online by Cambridge University Press:  08 March 2021

By
Nita Desai  and
Anna Reinert
Edited by
Michael Hibner
Michael Hibner
Affiliation:
St Joseph’s Hospital & Medical Center, Phoenix, AZ
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Summary

Among the physicians who see patients for pelvic pain some feel that the only proper treatment is surgery and others that nonsurgical treatment should be the mainstay of therapy. The truth of course lies in the middle, and the most effective providers are not only excellent surgeons but also recognize the importance of physical therapy, pharmacological treatments, and psychological counseling. One of the problems with assessing the effectiveness of surgery and comparing outcomes between the providers is that there are different skill levels, and what one provider calls complete resection of endometriosis or adhesiolysis another may deem as incomplete. In the hands of good and qualified surgeons some procedures unequivocally are beneficial for patients. Resection of endometriosis has clearly been shown to be beneficial provided other causes of pain are also treated. In our practice patients with complete adhesiolysis also seem to have good improvement of pain. It is true that pain may return with time but patients may have few good years, after which they may be candidates for a repeat procedure. Hysterectomy for pain is of course controversial, especially in younger or nulligravid patients.

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Chapter
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Management of Chronic Pelvic Pain
A Practical Manual
 , pp. 71 - 84
Publisher: Cambridge University Press
Print publication year: 2021

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References

Stratton, P. Evaluation of acute pelvic pain in nonpregnant adult women. UpToDate2016.Google Scholar
Kruszka, PS, Kruszka, SJ. Evaluation of acute pelvic pain in women. Am Fam Physician. 2010;82(2):141–7.Google Scholar
ACOG Committee on Practice Bulletins – Gynecology. Practice Bulletin 174: Evaluation and management of adnexal masses. Obstet Gynecol. 2016;128(5):e210–26.Google Scholar
Rivera Dominguez, A, Mora Jurado, A, Garcia de la Oliva, A, de Araujo Martins-Romeo, D, Cueto Alvarez, L. Gynecological pelvic pain as emergency pathology. Radiologia. 2017;59(2):115–27.Google Scholar
Gaitán Hernando, G, Reveiz, L, Farquhar, C, Elias Vanessa, M. Laparoscopy for the management of acute lower abdominal pain in women of childbearing age. Cochrane Database Syst. Rev. 2014;(5).Google Scholar
Decadt, B, Sussman, L, Lewis, MPN, Secker, A, Cohen, L, Rogers, C, et al. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg. 1999;86(11):1383–6.Google Scholar
Tu, F, As-Sanie, S, Evaluation of chronic pelvic pain in women. UpToDate 2018.Google Scholar
Lamvu, G, Williams, R, Zolnoun, D, Wechter, ME, Shortliffe, A, Fulton, G, Steege, JF. Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Am J Obstet Gynecol. 2006;195(2):591–8.Google Scholar
Lamvu, G, Robinson, B, Zolnoun, D, Steege, JF. Vaginal apex resection: a treatment option for vaginal apex pain. Obstet Gynecol. 2004;104(6):1340–6.Google Scholar
Swanton, A, Iyer, L, Reginald, PW. Diagnosis, treatment and follow up of women undergoing conscious pain mapping for chronic pelvic pain: a prospective cohort study. BJOG. 2006;113(7):792–6.CrossRefGoogle ScholarPubMed
Holloran-Schwartz, MB. Surgical evaluation and treatment of the patient with chronic pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):357–69.CrossRefGoogle ScholarPubMed
Howard, FM. The role of laparoscopy in chronic pelvic pain: promises and pitfalls. Obstet Gynaecol Surv. 1993;48(6):357–87.Google Scholar
Howard, FM. Laparoscopic evaluation and treatment of women with chronic pelvic pain. J Am Assoc Gynecol Laparosc. 1994;1(4 Pt 1):325–31.CrossRefGoogle ScholarPubMed
Howard, FM. The role of laparoscopy in the chronic pelvic pain patient. Clin Obstet Gynecol. 2003;46(4):749–66.Google Scholar
Kontoravdis, A, Chryssikopoulos, A, Hassiakos, D, Liapis, A, Zourlas, PA. The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. Int J Obstet Gynecol. 1996;52(3):243–8.Google Scholar
de Almeida Filho, DP, de Oliveira, LJ, do Amaral, VF. Accuracy of laparoscopy for assessing patients with endometriosis. São Paulo Med J. 2008;126(6):305–8.Google Scholar
Walter, AJ, Hentz, JG, Magtibay, PM, Cornella, JL, Magrina, JF. Endometriosis: correlation between histologic and visual findings at laparoscopy. Am J Obstet Gynecol. 2001;184(7):1407–13.Google Scholar
Wykes, CB, Clark, TJ, Khan, KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG. 2004;111(11):1204–12.Google Scholar
ElcombeL, S, Gath, D, Day, A. The psychological effects of laparoscopy on women with chronic pelvic pain. Psychol Med. 1997;27(5):1041–50.Google Scholar
Duffy, J, Arambage, K, Correa, F, Olive, D, Farquhar, C, Garry, R, Barlow, D. Laparoscopic surgery for endometriosis (Review). Summary Findings for the Main Comparison. Cochrane Database Syst Rev. 2014;(4).Google Scholar
Shakiba, K, Bena, JF, McGill, KM, Minger, J, Falcone, T. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further study. Obstet Gynecol. 2008;111(6):1285–92.CrossRefGoogle ScholarPubMed
Yeung, PP, Shwayder, J, Pasic, RP. Laparoscopic management of endometriosis: comprehensive review of best evidence. J Minim Invasive Gynecol. 2009;16(3):269–81.Google Scholar
Healey, M, Ang, WC, Cheng, C. Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation. Fertil Steril. 2010;94(7):2536–40.Google Scholar
Wright, J, Lotfallah, H, Jones, K, Lovell, D. A randomized trial of excision versus ablation for mild endometriosis. Fertil Steril. 2005;83(6):1830–6.Google Scholar
Chapron, C, Chopin, N, Borghese, B, Malartic, C, Decuypere, F, Foulot, H. Surgical management of deeply infiltrating endometriosis: an update. Ann NY Acad Sci. 2004;1034, 326–37.Google Scholar
Cao, Q, Lu, F, Feng, WW, Ding, JX, Hua, KQ. Comparison of complete and incomplete excision of deep infiltrating endometriosis. Int J Clin Exp Med. 2015;8(11):21497–506.Google Scholar
Chopin, N, Vieira, M, Borghese, B, Foulot, H, Dousset, B, Coste, J, et al. Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol. 2005;12(2):106–12.Google Scholar
Ianieri, MM, Mautone, D, Ceccaroni, M. Recurrence in deep infiltrating endometriosis: a systematic review of the literature. J Minim Invasive Gynecol. 2018.CrossRefGoogle Scholar
Laganà, AS, Vitale, SG, Trovato, MA, Palmara, VI, Rapisarda, AMC, Granese, R, et al. Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. BioMed Res Int. 2016.Google Scholar
Darwish, B, Stochino-Loi, E, Pasquier, G, Dugardin, F, Defortescu, G, Abo, C, Roman, H. Surgical outcomes of urinary tract deep infiltrating endometriosis. J Minim Invasive Gynecol. 2017;24(6):998–1006.CrossRefGoogle ScholarPubMed
Roman, H, Milles, M, Vassilieff, M, Resch, B, Tuech, JJ, Huet, E, et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol. 2016;215(6),762.e1–e9.Google Scholar
Darwish, B, Ron, H. Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol. 2016;215(2):195–200.Google Scholar
American Urogynecologic Society and American College of Obstetricians and Gynecologists. Elective coincidental appendectomy. ACOG Committee Opinion No. 323. Obstet Gynecol. 2005;106:1141–2.Google Scholar
Fayez, JA, Toy, NJ, Flanagan, TM. The appendix as the cause of chronic lower abdominal pain. Am J Obstet Gynecol. 1995;172(1), 122–3.Google Scholar
Lal, AK, Weaver, AL, Hopkins, MR, Famuyide, AO. Laparoscopic appendectomy in women without identifiable pathology undergoing laparoscopy for chronic pelvic pain. JSLS. 2013;17(1):82–7.Google Scholar
Moulder, J, Siedhoff, M, Melvin, K, Jarvis, E, Hobbs, K, Garrett, J. Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis. Int J Gynecol Obstet. 2017;139:149–54.Google Scholar
Howard, FM, El-Minawi, AM, Sanchez, RA. Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol. 2000;96(6):934–9.Google Scholar
Gerner-Rasmussen, J, Burcharth, J, Gögenur, I. The efficacy of adhesiolysis on chronic abdominal pain: a systematic review. Langenbecks Arch Surg. 2015;400(5):567–76.Google Scholar
Molegraaf, MJ, Torensma, B, Lange, CP, Lange, JF, Jeekel, J, Swank, DJ. Twelve-year outcomes of laparoscopic adhesiolysis in patients with chronic abdominal pain: a randomized clinical trial. Surgery (US). 2017;161(2):415–21.Google ScholarPubMed
Cheong, YC, Reading, I, Bailey, S, Sadek, K, Ledger, W, Li, TC. Should women with chronic pelvic pain have adhesiolysis? BMC Womens Health. 2014;14(1):1–7.Google Scholar
Hart, R, Hickey, M, Maouris, P, Buckett, W, Garry, R. Excisional surgery versus ablative surgery for ovarian endometriomata: a Cochrane Review. Cochrane Database Syst Rev. 2008;(2).Google Scholar
Sinha, A, Ewies, AAA. Ovarian mature cystic teratoma: challenges of surgical management. Obstet Gynecol Int. 2016.CrossRefGoogle Scholar
Parker, WH, Broder, MS, Liu, Z, Shoupe, D, Farquhar, C, Berek, JS. Ovarian conservation at the time of hysterectomy for benign disease. Clin Obstet Gynecol. 2007;50(2):354–61.Google Scholar
Kjerulff, KH, Langenberg, PW, Rhodes, JC, Harvey, LA, Guzinski, GM, Stolley, PD. Effectiveness of hysterectomy. Obstet Gynecol. 2000;95(3):319–26.Google Scholar
Casiano, E, Trabuco, E, Bharucha, A, Weaver, A, Schleck, C, Melton, LJ, Gebhart, J. Risk of oophorectomy after hysterectomy. Obstet Gynecol. 2013;121(5):1069–74.Google Scholar
Namnoum, AB, Hickman, TN, Goodman, SB, Gehlbach, DL, Rock, JA. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995;64(5):898–902.Google Scholar
Wu, J, Wechter, M, Geller, E, Nguyen, T, Visco, A. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110, 1091–5.CrossRefGoogle ScholarPubMed
Hillis, SD, Marchbanks, PA, Peterson, HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol. 1995;86(6):941–5.Google Scholar
Martin, DC. Hysterectomy for treatment of pain associated with endometriosis. J Minim Invasive Gynecol. 2006;13(6):566–72.CrossRefGoogle ScholarPubMed
Rizk, B, Fischer, AS, Lotfy, HA, Turki, R, Zahed, HA, Malik, R, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vision ObGyn. 2014;6(4):219–27.Google Scholar
Beard, RW, Kennedy, RG, Gangar, KF, Stones, RW, Rogers, V, Reginald, PW, Anderson, M. Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion. BJOG. 1991;98(10):988–92.Google Scholar
Chung, M-H, Huh, C-Y. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med. 2003.Google Scholar
Stovall, TG, Ling, FW, Crawford, DA. Hysterectomy for chronic pelvic pain of presumed uterine etiology. Obstet Gynecol. 1990.Google Scholar
Lamvu, G. Role of hysterectomy in the treatment of chronic pelvic pain. Obstet Gynecol. 2011;117(5):1175–8.Google Scholar
Hartmann, KE, Ma, C, Lamvu, GM, Langenberg, PW, Steege, JF, Kjerulff, KH. Quality of life and sexual function after hysterectomy in women with preoperative pain and depression. Obstet Gynecol. 2004;104(4):701–9.Google Scholar
Sharp, HT, Dodson, MK, Langer, KM, Doucette, RC, Norton, PA. The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia. Am J Obstet Gynecol. 2000;183(6), 1385–9.Google Scholar
Trehan, AK, Sanaullah, F. Laparoscopic posthysterectomy vaginal vault excision for chronic pelvic pain and deep dyspareunia. J Minim Invasive Gynecol. 2009;16(3):326–32.Google Scholar
Proctor, M, Latthe, P, Farquhar, C, Khan, K, Johnson, N. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2005;(4).Google Scholar
Zullo, F, Palomba, S, Zupi, E, Russo, T, Morelli, M, Sena, T, et al. Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis. Journal Am Assoc Gynecol Laparosc. 2004;11(1):23–8.Google Scholar
Liddle, A, Davies, A. Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology. 2007;22(3):100–4.Google Scholar
Venbrux, A, Lambert, D. Embolization of the ovarian veins as a treatment for patients with chronic pelvic pain caused by pelvic venous incompetence (pelvic congestion syndrome). Curr Opin Obstet Gynecol. 1999;11(4):395–9.Google Scholar
Gargiulo, T, Mais, V, Brokaj, L, Cossu, E, Melis, GB. Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome. J Am Assoc Gynecol Laparosc. 2003;10(4):501–4.Google Scholar
Borah, BJ, Nicholson, WK, Bradley, L, Stewart, EA. The impact of uterine leiomyomas: A national survey of affected women. Am J Obstet Gynecol. 2013;209(4):319.e1–e20.Google Scholar
Chen, S, Pitre, E, Kaunels, D, Singh, S. Uterine-preserving interventions for the management of symptomatic uterine fibroids: A systematic review of clinical and cost-effectiveness. Ottawa: CADTH Rapid Response Report, January 2016, 1–140.Google Scholar
Fortin, C, Flyckt, R, Falcone, T. Alternatives to hysterectomy: the burden of fibroids and the quality of life. Best Pract Res Clin Obstet Gynaecol. 2018;46:31–42.Google Scholar
Olson, LE, Dyer, JE, Haq, A, Ockrim, J, Greenwell, TJ. A systematic review of the literature on cystodistension in bladder pain syndrome. Int Urogynecol J. 2017;1–7.CrossRefGoogle Scholar
Niimi, A, Nomiya, A, Yamada, Y, Suzuki, M, Fujimura, T, Fukuhara, H, et al. Hydrodistension with or without fulguration of Hunner lesions for interstitial cystitis: long-term outcomes and prognostic predictors. Neurourol Urodyn. 2016;35(8):965–9.Google Scholar
Bhide, AA, Puccini, F, Khullar, V, Elneil, S, Alessandro Digesu, G. Botulinum neurotoxin type A injection of the pelvic floor muscle in pain due to spasticity: a review of the current literature. Int Urogynecol J. 2013;24(9):1429–34.Google Scholar
Purwar, B, Khullar, V. Use of botulinum toxin for chronic pelvic pain. Womens Health 2016;12(3):293–6.Google Scholar
Abbott, JA, Jarvis, SK, Lyons, SD, Thomson, A, Vancaille, TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol. 2006;108(4):915–23.Google Scholar
Hibner, M, et al. Poster presentation at International Pelvic Pain Society Annual Meeting; 2010.Google Scholar
Nesbitt-Hawes, EM, Won, H, Jarvis, SK, Lyons, SD, Vancaillie, TG, Abbott, JA. Improvement in pelvic pain with botulinum toxin type A – single vs. repeat injections. Toxicon. 2013;63(1):83–7.Google Scholar
Rogo-Gupta, L, Castellanos, M. When and how to excise vaginal mesh. Curr Opin Obstet Gynecol. 2016;28(4):311–15.Google Scholar
Wolff, GF, Winters, JC, Krlin, RM. Mesh excision: is total mesh excision necessary? Curr Urol Rep. 2016;17(4):1–7.Google Scholar
Hou, JC, Alhalabi, F, Lemack, GE, Zimmern, PE. Outcome of transvaginal mesh and tape removed for pain only. J Urol. 2014;192(3):856–60.Google Scholar
Rigaud, J, Pothin, P, Labat, J J, Riant, T, Guerineau, M, Le Normand, L, et al. Functional results after tape removal for chronic pelvic pain following tension-free vaginal tape or transobturator tape. J Urol. 2010;184(2):610–15.CrossRefGoogle ScholarPubMed
Crosby, EC, Abernethy, M, Berger, MB, DeLancey, JO, Fenner, DE, Morgan, DM. Symptom resolution after operative management of complications from transvaginal mesh. Obstet Gynecol. 2014;123(1):134–9.CrossRefGoogle ScholarPubMed
Cardenas-Trowers, O, Malekzadeh, P, Nix, D, Hatch, K. Vaginal mesh removal outcomes: eight years of experience at an academic hospital. Female Pelvic Med Reconst 2017;23(6):382–6.Google ScholarPubMed
Robert, R, Prat-Pradal, D, Labat, JJ, Bensignor, M, Raoul, S, Rebai, R, Leborgne, J. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat: SRA. 1998;20(2):93–8.Google Scholar
Dellon, AL, Coady, D, Harris, D. Pelvic pain of pudendal nerve origin: surgical outcomes and learning curve lessons. J Reconstruct Microsurg. 2015;31(4):283–90.Google ScholarPubMed
Moscatiello, P, Carracedo, CD, Yupanqui, GL, Rivera Martinez, ME, Mendiola de la Hoza, A, Sanchez Encinas, M. Robot-assisted pudendal neurolysis in the treatment of pudendal nerve entrapment syndrome. Actas Urol Esp. 2018;42(5):344–9.Google Scholar
Andrews, JC. Vulvodynia interventions-systematic review and evidence grading. Obstet Gynecol Surv. 2011;66(5):299–315.Google Scholar
Stenson, AL. Vulvodynia: diagnosis and management. Obstet Gynecol Clin North Am. 2017;44(3), 493–508.Google Scholar

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