Laparoscopic presacral neurectomy for chronic pelvic pain.

Presacral neurectomy is an effective treatment for chronic pelvic pain and dysmenorrhea. The theory behind presacral neurectomy for pain relief is based upon the anatomy of the sensory pathways from the pelvic viscera through the inferior and superior hypogastric plexus, located in the presacral area, to the spinal columns. The excision of the presacral nerve trunk can obstruct pain sensory pathways. Unfortunately 20-25% of patients treated medically for severe, disabling pelvic pain fail to show improvement. As a result, presacral neurectomy has become an alternative management for those with chronic pelvic pain and dysmenorrhea, especially for those who have failed to respond to medical treatment. Operative endoscopy further facilitates the adaptation of the laparoscopic approach to this pelvic denervation. The efficacy of pain relief by laparoscopic presacral neurectomy in chronic pelvic pain and dysmenorrhea is documented at about 75-80%. Major complications are rare with a rate of less than 1% reported. Laparoscopic presacral neurectomy therefore offers an effective alternative treatment and should also be considered as the initial surgical intervention for chronic pelvic pain.