Laparoscopy as a diagnostic and therapeutic tool in the management of chronic pelvic pain

Introduction- Chronic pelvic pain (CPP) is a complex, perplexing, disabling and distressing condition and is associated with poor quality of life, fatigue, depression, anxiety, marital and sexual dysfunction. This study aims at evaluating laparoscopy as a diagnostic as well as therapeutic tool in management of chronic pelvic pain.
Methods- This Retrospective study was conducted in Kasturba Hospital, Delhi. Medical records of 50 women with Chronic Pelvic pain of greater than 6 months duration, who underwent laparoscopy from January 2017 to March 2020, were reviewed.
Results- Laparoscopy revealed adhesions as most common pathology in 17 (34%) patients. Sharp adhesiolysis was done in all cases. Endometriosis was identified in 14 (28%) with variable presentation like chocolate cyst (6%), only endometriotic spots(2%), and both(20%). Endometrioma cystectomy (12%), deroofing and fulguration of cyst (14%) and ablation of endometriotic spots (22%) were the surgeries performed. Chronic PID was diagnosed in 12(24%). Salpingostomy was performed in all the 4 women with hydrosalpinx. Fibroids were seen in 6 (12%) patients. Genital Kochs was diagnosed in 3 (6%) patients, as confirmed by presence of AFB. Ovarian cysts were identified in 5 (10%) patients among whom dermoid cyst in 2(4%), simple ovarian cyst in 2 (4%) and para-ovarian cyst in 1(2%). Cystectomy was done in all 5 patients. 13(26%) patients had no abnormality detected.
Conclusion- Laparoscopy is the gold standard in management of chronic pelvic pain. It provides confirmation of diagnosis with surgical treatment by minimally invasive techniques thus it also avoids the morbidity of laparotomy.