adhesiolysis for chronic pelvic pain
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:
1. Sometimes pelvic infection leaves scars around the uterus
and ovaries leading to pain. Release of painful adhesions through the laparoscope could give relief.
2. Severe pain
during periods not cured with medicines could be treated by a procedure
called uterosacral nerve vaporization.
3. In patients
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
pelvic pain is due to dilated veins near the uterus. These veins extend to
the side of the ovary and sometimes may go upto the upper abdomen.. This
is called pelvic venous congestion. Proper
diagnosis 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.
no abnormality is found on
doing a laparoscopy and in these instances it is my practice to show them
the videocassette of the procedure,and then the patients are ready to
accept the pain or control it with simple analgesics as they have the
happy knowledge that nothing serious is wrong with them.
6. In some
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.
Laparoscopic release of these adhesions may give symptom
relief. The author has done about 10 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