부산대학교 도서관

OBJECTIVE: The aim of this study was to assess the efficacy of laparoscopic resection of pelvic peritoneum in addition to conventional laparoscopic uterosacral nerve ablation (LUNA) procedure on the relief of treatment refractory pelvic pain in patients without preoperative diagnosis of endometriosis.METHODS: We performed laparoscopic peritonectomy combined with LUNA in 13 patients who had not been diagnosed as endometriosis. Intraoperative findings were re-assessed by videos recorded during surgery. Peritoneal specimens were pathologically reviewed. Postoperative details on dysmenorrhoea, chronic pelvic pain (CPP), dyspareunia and dyschezia were evaluated using an interview-based questionnaire.RESULTS: Five out of all 13 cases were diagnosed as endometriosis post operatively. In 8 cases without endometriosis, 4 had peritoneal adhesion, 3 had suspicion of infection and 3 without any abnormal findings. The pathological observations showed scar and fibrosis of peritoneum in 4 cases, and neutrophil and eosinophil accumulation around the endothelium of vessels in 4 cases, suggesting localized inflammation. There was significant reduction in dysmenorrhea and CPP at 12 months follow up. The pain outcomes associated with intercourse or evacuation were reduced post operatively, either. There were no particular intra or postoperative complications observed. Three women needed post operative treatment with NSAIDs and/or oral contraceptives.CONCLUSION: Laparoscopic peritonectomy combined with LUNA seems safe and effective procedure to alleviate pelvic pain in patients without preoperative diagnosis of endometriosis.