Laparoscopy on Account of Chronic Pelvic Pain: a Retrospective
Clinical Study
Mára M., Fučíková Z., Kužel D., Dohnalová A., Haaková L., Živný J.:
Gynekologicko-porodnická klinika 1. LF UK a VFN, přednosta prof. MUDr. J. Živný, DrSc. Fyziologický ústav 1. LF UK v Praze – oddělení kybernetiky, přednosta prof. MUDr. S. Trojan, DrSc. |
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Summary:
Objectives: To analyze the laparoscopic findings in women with chronic pelvic pain (CPP). To
verify the possible predictive value of the anamnestic factors for the laparoscopically established
diagnosis.
Design: A retrospective clinical trial.
Setting: Department of Obstetrics and Gynaecology, lst Faculty of Medicine and the General
Faculty Hospital, Charles University, Prague.
Methods: We realized a detailed analysis of laparoscopies for CPP performed in our clinic in the
last 5 years. With the help of statistical analysis (c
2
) the possible influence of age, previous
surgical 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 frequent
findings 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 women
older than 30 pelvic adhesions were the most often (31.9%). Diversity of findings between the
groups was statistically significant (P < 0.0001). In patients with previous operation in pelvis the
adhesions were found most frequently (46.2%). Diversity of findings in women with and without
previous 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 was
diagnosed. 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 most
frequently (41.2%). A suspicion of chronic appendicitis was verified in 64.3%. In patients with
dysmenorrhea, as well as in women suffering from dyspareunia, endometriosis was dominant
finding (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 laparoscopic
findings are predictible; although the sensitivity and specificity is very poor.
Key words:
chronic pelvic pain, laparoscopy, laparoscopic finding prediction
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