Should women with chronic pelvic pain have adhesiolysis?

Cheong, Ying; Reading, Isabel; Bailey, Sarah; Sadek, K.; Ledger, William; Li, Tin C.

doi:10.1186/1472-6874-14-36

Cited by 34 publications

(25 citation statements)

References 24 publications

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“…Although our study population composed of only women without a history of pelvic surgery except for cesarean section, adhesion was still in the first place. In the literature, the most frequent coexistence is with adhesion, as well [23][24][25][26]. Kontoravdis et al performed laparoscopy on 1629 patients with CPP and identified adhesion in 577 (35.4%) of them [23].…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic Uterine Nerve Ethanol Neurolysis (LUNEN) in Patients with Chronic Pelvic Pain

Sönmez¹,

Naykı²,

Ulug³

et al. 2016

Journal of Clinical and Experimental Investigations

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ÖZETAmaç: Kronik pelvik ağrılı (KPA) hastalarda ağrı tedavisinde laparoskopik olarak uterin sinirin etanol ile nörolizi-sinin (LUNEN) etkinliğinin araştırılması Yöntemler: Kimyasal bir nörolizis prosedürü olan LU-NEN, 22 hastaya uygulandı ve bunlar sadece tanısalk laparoskopi yapılan 20 kontrol hastayla karşılaştırıldı. Tedavi öncesi ve tedavi sonrası altıncı ayda Vizüel Analog Skalası (VAS) değerlendirildi, Ayrıca, ağrı kontrolünde hasta memnuniyetini sorgulayan subjektif bir ağrı değer-lendirmesi yapıldı. Methods: LUNEN, as a chemical neurolysis procedure, was performed on 22 subjects, and these were compared with 20 controls that had a diagnostic laparoscopy alone. Pre-treatment and postoperative 6 th month Visual Analogue Scale (VAS) scores were estimated and a subjective pain evaluation questioning patients' satisfaction about pain relief in the 6th month after surgery was also performed.Results: A total of 31 (73.8%) out of 42 CPP patients had a laparoscopic pelvic pathology. Preoperative VAS scores were similar in the groups; however, the mean postoperative VAS score was significantly lower in the LUNEN group than in the control group (3.18 ± 2.88 vs. 5.35 ± 3.09; p=0.02). In the LUNEN group, the number of patients who stated that their pain was relieved partially or completely was also significantly higher than in the control group (82% vs. 40%, p=0.019). Conclusion:LUNEN is a feasible, safe and effective surgical alternative to traditional surgical methods in patients suffering from CPP. J Clin Exp Invest 2016; 7 (1): 7-13

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Section: Resultsmentioning

confidence: 99%

Laparoscopic Uterine Nerve Ethanol Neurolysis (LUNEN) in Patients with Chronic Pelvic Pain

Sönmez¹,

Naykı²,

Ulug³

et al. 2016

Journal of Clinical and Experimental Investigations

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“…The method of conduct of this RCT is similar to studies previously conducted by our group [9]. Randomization was performed using computer-generated random numbers and the concealed, opaque, unlabeled envelope was opened after it had been determined that the patient met the intraoperative criteria.…”

Section: Methodsmentioning

confidence: 99%

Randomized Controlled Trial of Hyalobarrier® Versus No Hyalobarrier® on the Ovulatory Status of Women with Periovarian Adhesions: A Pilot Study

2016

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IntroductionPeriadnexal adhesions are known to contribute to subfertility. The restoration of the tubo-ovarian anatomy is one the key principles in reproductive surgery, and this involves adhesiolysis. However, adhesion formation/reformation is very common after periovarian adhesiolysis. It is not known if the application of Hyalobarrier®, an anti-adhesion gel, around the adnexal region postsurgery influences ovulatory status. The study is a pilot randomized controlled trial (RCT) randomizing women into the application of Hyalobarrier® versus no Hyalobarrier® at the time of laparoscopy, where postsurgical ovulatory status and pregnancy rates were evaluated.MethodsThis was a pilot RCT where women were recruited from the gynecological and subfertility clinic who were deemed to require an operative laparoscopy. If intraoperatively they were found to have periovarian adhesions, they were randomized into having adhesiolysis with and without usage of Hyalobarrier®. Demographic details and intraoperative details including the severity, extent, and the ease of use of Hyalobarrier® were recorded. Prior to the surgery and postoperatively, the participants had their serum hormonal status (day 2 FSH, LH and day 21 progesterone) evaluated. Postoperatively, they underwent a follicular tracking cycle at 3 months.ResultsFifteen women were randomized into use of Hyalobarrier® (study group) and 15 into the no Hyalobarrier® group (control group) between December 2011 and January 2014. There was no difference in the patient characteristics in terms of age, BMI, the number of previous pregnancies, or the extent, site, and severity of adhesions between the two groups. There was no significant difference between the study versus control groups in terms of the hormonal profile (day 2 FSH and day 21 progesterone) before or after surgery. The 3-month postoperative day 10–12 follicular tracking findings and endometrial thickness were similar between the study and control groups. Four women were pregnant in the study group (24%) and one in the control group (7%) cumulatively over 2 years.ConclusionThe use of Hyalobarrier® post salpingo-ovariolysis did not influence follicular development as inferred from the results of the day 21 progesterone and folliculogram on day 10–12 3-month postsurgery.Trial RegistrationISRCTN number, ISRCTN1833588.FundingNordic Pharma.

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“…49,50 For example, adhesiolysis may be performed in what started as a diagnostic procedure. 51 Depending on the severity and corresponding patient consent, endometriosis may be treated at the time of diagnosis by either electrocoagulation, laser vaporisation or excision. 52 Endometrioma and benign ovarian cysts are usually excised.…”

Section: Treatment Of Chronic Pelvic Painmentioning

confidence: 99%

MRI versus laparoscopy to diagnose the main causes of chronic pelvic pain in women: a test-accuracy study and economic evaluation

Khan

Tryposkiadis

Tirlapur

et al. 2018

Health Technol Assess

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Should women with chronic pelvic pain have adhesiolysis?

Cited by 34 publications

References 24 publications

Laparoscopic Uterine Nerve Ethanol Neurolysis (LUNEN) in Patients with Chronic Pelvic Pain

Laparoscopic Uterine Nerve Ethanol Neurolysis (LUNEN) in Patients with Chronic Pelvic Pain

Randomized Controlled Trial of Hyalobarrier® Versus No Hyalobarrier® on the Ovulatory Status of Women with Periovarian Adhesions: A Pilot Study

MRI versus laparoscopy to diagnose the main causes of chronic pelvic pain in women: a test-accuracy study and economic evaluation

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