Bilateral Laparoscopic Transperitoneal Ligation of Ovarian Veins for Treatment of Pelvic Congestion Syndrome

Gargiulo, T; Mais, Valerio; Brokaj, Lindita; Cossu, Ester; Melis, Gian Benedetto

doi:10.1016/s1074-3804(05)60156-9

Cited by 69 publications

(37 citation statements)

References 14 publications

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“…Improvements in pelvic pain were generally seen; for example, in a 2003 study of 23 women undergoing laparoscopic ligation, 78% were pain-free at 6 months postoperatively and showed no menopausal symptoms. 33 There are no randomised trials, however, and so a relative treatment effect cannot be defined. Endovascular techniques have supplanted ligation, as they are capable of being performed under conscious sedation, are quicker and have a shorter recovery period.…”

Section: Pelvic Vein Ligationmentioning

confidence: 99%

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

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BackgroundPelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.ObjectivesOur proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.Data sourcesA comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.MethodsMethodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.ResultsWe identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.ConclusionsThe data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case–control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.Study registrationThis study is registered as PROSPERO CRD42012002237 and CRD42012002238.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Pelvic Vein Ligationmentioning

confidence: 99%

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Champaneria

Shah

Moss³

et al. 2016

Health Technol Assess

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“…2 We report a woman with pelvic varicosities, who was treated by sclerotherapy during laparoscopy. Although bilateral, laparoscopic transperitoneal ligation of ovarian vessels for treatment of pelvic congestion syndrome (PCS) has been reported previously, 3 we are unaware of any published reports of sclerotherapy to treat this condition.…”

Section: Introductionmentioning

confidence: 99%

Case report: Laparoscopic sclerotherapy in a case of pelvic congestion syndrome

Ghosh

Shafie-Pour

Ayers

2006

BJOG

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“…Эф фективность внебрюшинной резекции гонадных вен в ликвидации тазовых болей при ТВП составля ет 73-95% [4,5]. Другие авторы [6] сообщают о вы сокой эффективности эндоскопической резекции гонадных вен при ТВП, достигающей 80-90%. До статочно существенный разброс данных, отсутствие точных показаний к хирургическому лечению ТВП, отсутствие алгоритма выбора способа операции диктуют необходимость сравнительной оценки эф фективности различных хирургических методик ле чения ТВП.…”

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Results of Different Types of Operations in Patients with Pelvic Congestion Syndrome

Янина¹,

Кириенко²,

Sg³

et al. 2016

Flebol.

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Bilateral Laparoscopic Transperitoneal Ligation of Ovarian Veins for Treatment of Pelvic Congestion Syndrome

Cited by 69 publications

References 14 publications

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness

Case report: Laparoscopic sclerotherapy in a case of pelvic congestion syndrome

Results of Different Types of Operations in Patients with Pelvic Congestion Syndrome

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