Pain mapping of adhesions.

STUDY OBJECTIVE

To determine the nature and location of adhesions and their relationship to abdominal pain in patients undergoing awake microlaparoscopy.

DESIGN

Retrospective analysis (Canadian Task Force classification II-1).

SETTING

University teaching hospital.

PATIENTS

Thirty women ages 26-49 years with chronic pelvic pain were studied over a 9-month period.

INTERVENTION

Patients were kept awake during their laparoscopy to determine the site and degree of pain when the adhesions were palpated.

MEASUREMENTS AND MAIN RESULTS

Patients with abdominal pain and a history suggestive that the pain was due to adhesions underwent an awake laparoscopy. Visual analog scores were used to evaluate the pain on palpation of the adhesion as it related to the nature of the adhesion as well as the location of the adhesion. Filmy adhesions that allowed for movement between two structures had the highest association with pain. Fixed adhesions that did not allow movement had the lowest pain scores. Adhesions that had a relationship to the peritoneum had a high association with pain.

CONCLUSION

Filmy adhesions between a movable structure, such as an ovary, and the peritoneum had the highest pain scores. Fixed or dense adhesions, no matter where they were located, had the lowest pain scores.