Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus.

OBJECTIVE To report our experience with endopelvic causes for sacral radiculopathies and sciatica. DESIGN Prospective cohort study. SETTING Tertiary referral advanced laparoscopic gynecology and neuropelveologic unit. PATIENT(S) Two hundred thirteen women who underwent laparoscopic management of sacral radiculopathy (sciatica, pudendal, gluteal pain) of unknown genesis in the period between November 2004 and February 2010. INTERVENTION(S) Selective, clinically oriented, laparoscopic exploration of the sacral plexus with nerve decompression. MAIN OUTCOME MEASURE(S) Complication rates and the short-term cure at 6-month follow-up with use of the Visual Analogue Scale. RESULT(S) Laparoscopic exploration showed isolated endometriosis of the sciatic nerve in 27 patients, deeply infiltrating parametric endometriosis with sacral plexus infiltration in 148 patients, sacral plexus vascular entrapment in 37 patients, and pyriformis syndrome in one patient. A reduction in mean ± SEM) Visual Analogue Scale score of patient pain from 7.7 (± 1.16; range 6-10) before surgery to 2.6 (± 1.77; range 0-6) at 6-month follow-up was obtained for sacral plexus endometriosis and from 6.6 (± 1.43; range 5-9) to 1.5 (± 1.27; range 0-4) for vascular entrapment. CONCLUSION(S) In patients with chronic pelvic pain, preoperative anamnesis and examination should include evaluation of symptoms of sacral radiculopathies (pudendal, gluteal pain) and sciatic neuralgia. In patients with sacral radiculopathy or sciatica of unknown genesis, suspicion of endopelvic pathology such as endometriosis or vascular entrapment must be raised, and laparoscopic exploration of the sacral plexus and/or sciatic nerve is then advisable.