Gynaecology Thrissur

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Laparoscopic 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

 

4. Sometimes 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 India. 

  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.

5. Sometimes 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

What it involves for the Patient:

Usually the 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 repair.

 

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