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

Yıl 2016, , 7 - 13, 01.03.2016

Seyhan Sönmez Ümit Naykı Paşa Uluğ Cenk Naykı Ferhan Sönmez Şivekar Tınar Yusuf Yıldırım

https://doi.org/10.5799/jcei.328658

Öz

Objective: To investigate the efficacy of laparoscopic uterine nerve ethanol neurolysis (LUNEN) for pain management
in patients with chronic pelvic pain (CPP).
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 6th 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

Anahtar Kelimeler

Chronic pelvic pain, uterine nerve neurolysis, laparoscopy, ethanol

Kaynakça

• 1. Duffy S. Chronic pelvic pain: defining the scope of the problem (2001) Int J Gynaecol Obstet 2001;74:3-7.
• 2. Palomba S, Russo T, Falbo A, et al. Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: A randomized study. Eur J Obstet Gynecol Reprod Biol 2006;129:84–91.
• 3. Zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community symptoms, investigation, and diagnoses. Am J Obstet Gynecol 2001;184:1149–1155.
• 4. Stein SL. Chronic pelvic pain. Gastroenterol Clin North Am 2013;42:785-800.
• 5. Weijenborg PT, Greeven A, Dekker FW, et al. Clinical course of chronic pelvic pain in women. Pain 2007;132:117–123.
• 6. Porpora MG, Gomel V. The role of laparoscopy in the management of pelvic pain in women of reproductive age. Fertil Steril 1997;68:765–779.
• 7. Carter JE. Surgical treatment for chronic pelvic pain. JSLS 1998;2:129–139.
• 8. Sharma D, Dahiya K, Duhan N, Bansal R. Diagnostic laparoscopy in chronic pelvic pain. Arch Gynecol Obstet 2011;283:295-297
• 9. Demir F, Ozcimen EE, Oral HB. The role of gynecological, urological, and psychiatric factors in chronic pelvic pain. Arch Gynecol Obstet 2012;286:1215-1220.
• 10. Frankenhauser G. Die Bewegungenerven der Gebarmutter. Z Med Nat Wiss 1864;1:35.
• 11. Johnson NP, Farquar CM, Crossley S, et al. A doubleblind randomized controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain. BJOG 2004;111:950–959.
• 12. Daniels J, Gray R, Khan KS, Gupta J. Laparoscopic uterine nevre ablation: a survey of gynaecological practice in UK. Gynecol Endosc 2000;9:157–159.
• 13. Davis GD. Uterine prolapse after laparoscopic uterosacral transection in nulliparous airborne trainees: a report of three cases. J Reprod Med 1986;41:279-282.
• 14. Patt RB. Cancer pain. In Patt RB(ed):Cancer Pain. Lippincott, Philadelphia, 1993, pp377-425.
• 15. Rowe DS. Neurolytic techniques for pain management. Pain Clin 1995; 8:107-115.
• 16. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996;87:321–327.
• 17. Kresch AJ, Seifer DB, Sachs LB, Barrese I Laparoscopy in the evalution of 100 women with chronic pelvic pain. Obstet Gynecol 1984;64:672.
• 18. Vercellini P, Fedele L, Molteni P, et al. Laparoscopy in the diagnosis of gynecologic chronic pelvic pain. Int J Gynaecol Obstet 1990;32:261-265.
• 19. Levitan Z, Eibschitz I, de Vries K, et al. The value of laparoscopy in women with chronic pelvic pain and a “normal pelvis”. Int J Gynaecol Obstet 1985;23:71-74.
• 20. Florido J, Pérez-Lucas R, Navarrete L. Sexual behavior and findings on laparoscopy or laparotomy in women with severe chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol 2008;139:233-236.
• 21. Drozgyik I, Vizer M, Szabo. Significance of laparoscopy in the management of chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol 2007;133:223-226
• 22. Cox L, Ayers S, Nala K, Penny J. Chronic pelvic pain and quality of life after laparoscopy. Eur J Obstet Gynecol Reprod Biol 2007;132:214-219
• 23. Kontoravdis A, Chryssikopoulos A, Hassiakos D, et al. The diagnostic value of laparoscopy in 2365 patients with acut and chronic pelvic pain. Int J Gynecol Obstet 1996;52;243- 248.
• 24. Carter JE. Laparoscopic finding in patients with chronic pelvic pain. J Am Assoc Gynecol Laparoscopy 1994;2:43-47.
• 25. Roseff SJ, Murphy AA. Laparoscopy in the diagnosis and therapy of chronic pelvic pain. Clin Obstet Gynecol 1990;33:137-141.
• 26. Cheong YC, Reading I, Bailey S, et al. Should women with chronic pelvic pain have adhesiolysis? BMC Womens Health 2014;14:36.
• 27. Cornillie FJ, Oosterlynck D, Lauweryns J, Konnicks PR. Deeply infiltrating pelvic endometriosis; histology and clinical significance. Fertil Steril 1993;53:978-983.
• 28. Cheong YC, Smotra G, Williams AC (2014) Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev 2014 5;3: CD008797.
• 29. De Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain 1993;54:145–151.
• 30. Pollitt CI, Salota V, Leschinskiy D. Chemical neurolysis of the superior hypogastric plexus for chronic non-cancer pelvic pain. Int J Gynaecol Obstet 2011;114:160-161.
• 31. Walid MS, Heaton RL. Neurolysis with alcohol for deep dyspareunia caused by trigger points in the uterosacral stumps. J Minim Invasive Gynecol 2009;16:485-486.
• 32. Singler RC. An improved technique for alcohol neurolysis of the celiac plexus. Anesthesiology 1982;56:137-141.