The role for laparoscopic presacral neurectomy.

This study was carried out to determine the efficacy of laparoscopic presacral neurectomy (LPSN) and to define its role in modern gynecology using a prospective consecutive cohort. One hundred three patients underwent LPSN, and 87 were included in this study. After LPSN, 91% of these 87 patients experienced some decrease in pelvic pain, and a majority of patients had 50% or greater reduction in pain score. There was a highly significant difference among the preoperative and postoperative pain levels (p less than 0.0001). Patients with pain of endometriosis (72), primary dysmenorrhea (5), and chronic pelvic inflammatory disease (10) responded with a decrease in pain score to this procedure. Complications included 1 patient with intraoperative bleeding, 2 with postoperative vaginal dryness, and 1 with constipation. We conclude that LPSN is as effective as that performed by laparotomy and should be offered to patients undergoing operative laparoscopy for central dysmenorrhea and pelvic pain. This procedure should be performed only by expert endoscopists experienced in the anatomy of this region.