adhesiolysis for chronic pelvic pain
Dr.Shobhana Mohandas, Consultant gynaecologist and laparoscopic surgeon, Sun Medical and Research centre, Thrissur, Kerala, India.
Continous low grade pain is a very common
condition found in middleaged women. Quite often it is due to some low
grade infection which can be cured when treated meticulously. In some
cases of chronic pelvic pain(Defined as persistent pain of more than 6
months duration), laparoscopy may be useful in evaluating
and curing the disease
How laparoscopy can be useful:
Sometimes pelvic infection leaves scars around the uterus
and ovaries leading to pain. Release of painful adhesions through the laparoscope could give relief. In the picture, the ovary is found stuck to the abdmominal wall. Every time the woman ovulates she would get severe pain due to this abnormal attachment. This could also give rise to painful menstrual periods. It may be difficult to detect this problem with any imaging modality except laparoscopy. Ultrasonography and CT scan may show no abnormality Sometimes, patients undergo hysterectomy for this condition, which is not necessary in all cases
with a disease called endometriosis , laparoscopy helps in diagnosing the
condition .Resection of endometriosis from all surfaces, specially the rectovaginal septal space could give relief.In the picture, the rectum is found adherent to the uterus and this adhesion is being released. I
pelvic pain is due to dilated veins near the uterus. These veins extend to
the side of the ovary andsometimes may go upto the upper abdomen.. This
is called pelvic venous congestion. Patients get severe
abdominal pain, menstrual pain, pain during intercourse,etc. Since they have many complaints, doctors sometimes also diagnose mental stress to be a cause of the problem. In the picture, the dilated blue veings can be seen by the side of the white ovaries and the long tubes.
diagnosis of pelvic venous congestion can be made only from laparoscopy.
The other definintive mode of diagnosis of this
condition,viz;venography is not done for this condition routinely in
After diagnosis proper medications could be given for cure.
If not properly diagnosed, many a time the woman may be subjected
to hysterectomy and this would not cure the disease and the woman would
end up undergoing a major surgery without getting cure for her illness.
patients who have undergone major surgery like LSCS or hysterectomy the
intestines may be adherent to the abdominal structures and may cause
colicky pain when food passes through the adherent segment. One such adhesion of intestine to the abdominal wall is seen in the picture. Laparoscopic release of these adhesions may give symptom
relief. The author has done several cases of severe intestinal adhesions
with good relief for the patients .
involves for the Patient:
patient is admitted the previous day, and an extensive bowel enema given . She is asked to be on oral fluids from the previous day. In case of minor adhesiolysis, she is allowed to go home the next
day. But if extensive intestinal adhesions , the patient is
observed for 4-5 days to make sure the intestines are working properly. Before surgery these patients are also warned about the possibility
of intestinal injury which might lead to opening of the abdomen for bowel