Laparoscopic Assessment of Chronic Pelvic Pain in Women – See and Fight Policy

Chronic Pelvic pain is a major cause of morbidity in reproductive years of women. This study was conducted to evaluate the laparoscopic findings in women with chronic pelvic pain, correlating its accuracy with clinical pelvic examination and managing treatable lesions at the same sitting. This was a prospective observational study conducted at Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, on one hundred and ten women with complaint of lower abdominal pain attending the OPD during the period from Sept. 2011 – Sept. 2012. The subjects included in the study were all reproductive age women with pain in the lower abdomen of at least 6 months duration occurring continuously or intermittently not associated with menstruation or sexual intercourse. Women beyond the age between 18 years to 50 years, pregnancy and its related causes, acute pelvic infection, Pelvic organ prolapse, Malignancy, congenital and acquired spinal deformities were excluded from the study group. All the eligible candidates were subjected to detailed clinical evaluation and transvaginal ultrasound with study of both hard and soft tissue markers followed by diagnostic laparoscopy. Findings were recorded and statistical analysis done using Yates Chi squire test in a 2 x 2 table. The mean age of patients was 30.31±7.03 years. Mean duration of pain was 2.61±1.25 years with 35.45% of the patients suffering from chronic pain of 2-3 years which was mild to moderate in severity. Most common primary complaint was dyspareunia in 83.64% women followed dysmenorrhoea (70%). The sensitivity of pelvic examination to diagnose the etiology of pelvic pain was 76.84% the correlation between clinical examination findings and laparocopic findings was not found to be statistically significant,(p value = 0.394). Laparoscopic examination showed some pelvic pathology in 86.36% most common of them was adhesions (54.55%), followed by endometriosis (25.45%). Twenty-two (20%) cases demonstrated hydrosalpinges, tuboovarian masses and adhesions suggestive of chronic pelvic inflammatory disease. Adhesiolysis, fulguration of endometriotic lesions, cyst aspiration done during the same sitting after obtaining informed consent. Thus, Laparoscopy is an excellent tool in evaluation of CPP in subject with no obvious physical signs and symptoms at the same time its use can be extended as a “see and fight” procedure in cases of obvious pelvic pathology.