Laparoscopic management of “pudendal pain” different endopelvic etiologies in 134 consecutive patients

Objective: To demonstrate the feasability of the laparoscopic transperitoneal approach to the pelvic somatetic 10 nerves for the diagnosis and treatment of ano-genital pain caused by pudendal and/or sacral nerve roots lesions. Method: In a retrospective review, 134 consecutive patients underwent laparoscopy for refractory ano-genital pain. All neurosurgical procedures such as neurolysis/decompression of the pudendal nerve and of the sacral nerve roots or implantation of neuroelectrode to the sacral plexus for postoperative neuromodulation were done by laparoscopic transperitoneal approach of the pelvic nerves. 15 Results: Eighteen patients had Alcock ́s canal syndrome and decompression was successful in 15. The three patients because of failure of the decompression underwent secondarly a sacral LION procedure with reduction at least 50% in pain VAS in all three. Sacral plexus lesions – radiculopathies -, most commonly post-surgical lesions and retroperitoneal endometriosis were found in 109 patients. All of these underwent a laparoscopic neurolysis of the sacral plexus; the final outcome depended on the etiology: For patients with post-surgical nerve 20 damage, 62% had a reduction of the mean preoperative VAS from 8,9 (±2,9, 7-10 ) to 2,4 (±2,3, 0-4) at time of submission this manuscript with a mean follow-up of 17 months (339 months). Eight of them underwent secondarly because of failure of decompression, a sacral LION procedure: A pain VAS reduction was obtained in five of them. For endometriosis lesion of the sacral plexus, 78% had a reduction of the mean preoperative VAS score of 8,7 (±1,9; 8-10) to 1,1 (±0,7, 0-2) at time of submission the manuscript (mean follow-up 21 months, 225 42 months). For vascular entrapment of pelvic nerves (n=6), all patients had complete relief. The last seven patients underwent primarly a sacral LION procedure with a pain VAS reduction at least 50% in four of them.