How can we reduce negative laparoscopies for pelvic pain?

Abstract

Chronic pelvic pain is a common condition and the RCOG guideline provides an evidence-based framework for the initial assessment. This study investigated the adequacy and relevance of the initial assessment in patients who underwent elective laparoscopic procedure for pelvic pain. History-taking was found to be deficient and was unable to identify factors which may be related to the cause or perception of the pain. Only a small percentage benefitted from a therapeutic trial of hormonal and non-hormonal agents and referral to other specialities. Ultrasound and bimanual examination were both found to be of little value. Laparoscopy assisted in diagnosis in 45% of patients. A structured initial assessment and targeted selection of patients for laparoscopy would reduce the number of patients with normal findings and thus, it would reduce the number of women who suffer pain and isolation after a negative laparoscopy.

When you see nothing at all: Outcomes following a negative laparoscopy. A systematic review

“…Laparoscopy can be a diagnostic tool allowing direct visualisation of the pelvis, and simultaneously be a therapeutic operation aiming to treat pathology, contingent on intra‐operative findings. Laparoscopy can influence clinical decision‐making, including adjustment of treatment plans and therapies or avoidance of unnecessary procedures 29,30 . However, it is controversial as to whether laparoscopic management of these pathologies is superior to other pain management modalities, such as hormonal suppression of menses 31 …”

“…Laparoscopy can influence clinical decision-making, including adjustment of treatment plans and therapies or avoidance of unnecessary procedures. 29,30 However, it is controversial as to whether laparoscopic management of these pathologies is superior to other pain management modalities, such as hormonal suppression of menses. 31 While commonplace, pelvic laparoscopy is not free from the risk of adverse events related to the anaesthesia and operation.…”