Can we avoid laparoscopy
in women with Chronic pelvic pain with no demonstrable palpable/ visible / sonological
cause for persistent pelvic pain?? Your opinion? Can we offer her a trial of medical therapy based on clinical examination
alone??
Ans:- We must be aware that “Chronic pelvic pain-CPP”
- frequently occurs secondary
to nongynecologic conditions that must be considered in the evaluation
of affected women. For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is
unnecessary, and a trial of medical therapy,
. In fact one can use second-line
therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other
indications for surgery .
Indications for surgery? If
therte is presence of a suspicious
adnexal mass.
\Laparoscopy or
opeb laparotomy?? Ans:-laparoscopic approaches seem to offer
comparable clinical outcomes to those performed via laparotomy, but with
reduced morbidity.
Q.6. what about adjuvant
post operative medical therapy postoperative medical therapy?? Ans:-Yes. Its beter for prevention.So, the
balance of evidence supports the use of adjuvant post operative medical therapy
after conservative surgery for CPP. There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently,
there is inadequate
evidence to support the use of uterosacral nerve ablation or uterine suspension.
Hysterectomy alone has undocumented value in the surgical management of women
with endometriosis-associated CPP.PMID: 12413979
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