Kronik pelvik ağrılı hastalarda laparoskopi sonuçlarının değerlendirilmesi

Abstract

Amaç: Çalışmamız, kronik pelvik ağrı (KPAS) tanısı ile laparoskopi yapılan hastaların laparoskopi sonuçlarını fertil ve infertil olmak üzere iki grupta retrospektif olarak değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Bu retrospektif çalışmada, KPAS nedeniyle laparoskopi yapılan 170 hastanın elektronik kayıtları incelendi. Hastalar vaka grubu olarak KPAS ve açıklanamayan infertilite grubu (n: 87) ve kontrol grubu olarak KPAS fertil grubu (n: 83) olmak üzere iki gruba ayrıldı. 25-40 yaş arası açıklanamayan infertilite ve KPAS olan kadınlar çalışmaya dahil edildi. Bulgular: Kadınlarda infertilite ile laparoskopi sonuçları arasında istatistiksel olarak anlamlı bir ilişki buldu (p<0,001). Kadınlarda infertilite ile semptomlar arasında istatistiksel olarak anlamlı bir ilişki yoktu (p>0,05). Kadınların infertilitesi ile sigara içme durumu arasında istatistiksel olarak anlamlı bir ilişki yoktu (p>0,05). Mann-Whitney testi, yaş ve vücut kitle indeksi (VKİ) açısından olgu ve kontrol arasında istatistiksel olarak anlamlı bir ilişki bulmadı (p>0,05). Ağrı süresi açısından gruplar arasında istatistiksel olarak anlamlı fark vardı (p<0,05). Olgu grubundaki ağrı süresi (Ort=5,34; SD=1,67), kontrol grubundaki ağrı süresinden (Ort=4,8; SD=1,72) daha uzundu. Sonuç: Sonuçlar, infertil grupta ağrı süresinin fertil gruptan anlamlı olarak daha yüksek olduğunu gösterdi ve bu durum esas olarak endometriozise atfedilebilir.

Keywords

• Laparoskopi
• kronik pelvik ağrı
• kısırlık

Evaluation of laparoscopy results for the patients with chronic pelvic pain

Abstract

Aim: The study aims to retrospectively evaluate the laparoscopy results of patients who underwent laparoscopy with chronic pelvic pain (CPPS) diagnosis in two groups of fertile and infertile patients. Material and Method: This retrospective study examined the electronic records of 170 patients who underwent laparoscopy due to CPPS were included in the study. The patients were divided into two groups: the CPPS and unexplained infertility group (n: 87) as the case group and the CPPS fertile group (n: 83) as the control group. Women aged 25-40 years with unexplained infertility and CPPS were included in the study. Results: Results found a statistically significant association between infertility in women and laparoscopy results (p<0.001). There was no statistically significant association between infertility in women and symptoms (p>0.05). There was no statistically significant association between women’s infertility and smoking status (p>0.05). Mann-Whitney test did not find a statistically significant association between case and control regarding age and body mass index (BMI) (p>0.05). There was a statistically significant difference between groups in terms of the duration of pain (p<0.05). The duration of pain in the case group (M=5.34; SD=1.67) was higher than the duration of pain in controls (M=4.8; SD=1.72). Conclusion: Results showed that the duration of pain in the infertile group was significantly higher than in the fertile group, which could mainly be attributed to endometriosis.

Keywords

• Laparoscopy
• chronic pelvic pain
• infertility

References

1. Abdelsattar AA, Nossir WS, Elsayed YA. Value of laparoscopy in diagnosis of endometriosis in unexplained infertility cases. ZUMJ 2020. doi: 10.21608/zumj.2020.16275.1460
2. Gawad Hadwa IMA, Raof Farahat MA, Saeed Dawood AE, Al Ahwal LM. Laparoscopic assessment of the tubo ovarian relationship in unexplained infertility. JAMMR 2022: 34: 86-98.
3. Argentino GLS, Bueloni-Dias FN, Leite NJ, et al. The role of laparoscopy in the propaedeutics of gynecological diagnosis1. Acta Cir Bras 2019; 34: e20190010000010.
4. Gokmen Karasu AF, Ates S, Gurbuz T, Sahin N, Takmaz T, Aydin S. A clinico-pathological study of transvaginal endometrial thickness measurement in asymptomatic postmenopausal patients and patients with postmenopausal bleeding. Gynecol Obstet Reprod Med 2019; 25: 85-8.
5. Raees HB. Critical analysis of laparoscopic diagnosis in gynecology: new era in healthcare. CMRO 2021: 4; 961-6.
6. El-flahgy MMM, El-Bassioune WM, Ayad WA. Incidence of endometriosis among women prepared for laparoscopy in unexplained infertility and chronic pelvic pain. IJMA 2020: 2; 519-27.
7. Gratton SM, Choudhry AJ, Vilos GA, et al. Diagnosis of endometriosis at laparoscopy: a validation study comparing surgeon visualization with histologic findings. J Obstet Gynaecol Can 2022; 44: 135-41.
8. Harris A, McCaughey T, Tsaltas J, et al. Endometriosis-related pelvic pain following laparoscopic surgical treatment. JEPPD 2020; 12: 151-7.

9. Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG. Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG 2019; 126: 1414-6.
10. Mak J, Leonardi M, Condous G. ‘Seeing is believing’: arguing for diagnostic laparoscopy as a diagnostic test for endometriosis. Reprod Fertil 2022; 3: 23-8.
11. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-60.
12. Singh A, Pandey K, Arya S, Ahmad A. Role of interleukin-8 in predicting endometriosis in patients with chronic pelvic pain & infertility. Pain 2020; 39: 11.
13. Laguerre MD, Arkerson BJ, Robinson MA, Moawad NS. Outcomes of laparoscopic management of chronic pelvic pain and endometriosis. J Obstet Gynaecol 2022; 42: 146-52.
14. Dokuzeylül Güngör N, Gürbüz T, Demir MK, Yapıcıer Ö, Zer L,Sağıroğlu JŞ. Endometriosis in an Episiotomy Scar:Case Report. TJRMS 2018; 2: 30-4.
15. Koninckx PR, Ussia A, Keckstein J, Adamyan L, Wattiez A, Martin DC. Prevalence of Endometriosis and Peritoneal Pockets in Women with Infertility and/or Pelvic Pain. J Obstet Gynaecol Can 2021; 43: 935-42.
16. Okcu NT, Gürbüz T, Uysal G. Comparison of patients undergoing vaginal hysterectomy with sacrospinous ligament fixation, laparoscopic hysterectomy with sacrocolpopexy and abdominal hysterectomy with sacrocolpopexy in terms of postoperative quality of life and sexual function. J Gynecol Obstet Hum Reprod 2021; 50: 101977.
17. Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Hum Reprod Update 2021; 28: 92-131.
18. Malhotra N, Singh UB, Iyer V, Gupta P, Chandhiok N. Role of laparoscopy in the diagnosis of genital tb in infertile females in the era of molecular tests. J Minim Invasive Gynecol 2020; 27: 1538-44.
19. McGuinness B, Nezhat F, Ursillo L, Akerman M, Vintzileos W, White M. Fallopian tube endometriosis in women undergoing operative video laparoscopy and its clinical implications. Fertil Steril 2020; 114: 1040-8.
20. Nuelly PMSS, Jostin BGR, Emery ELM, et al. Indication of laparoscopy in case of tubal infertility at the University Hospital of Brazzaville (Republic of Congo). J Gynecol Obstet 2022: 10; 120-5.
21. Panwar A, Lata K, Davis AA, Kriplani A. Spilled gallstones as an unusual cause of infertility: laparoscopic management. J Minim Invasive Gynecol 2020; 27: 1467-8.
22. Ploteau S, Merlot B, Roman H, Canis M, Collinet P, Fritel X. Endométriose minime à légère: résultats du traitement chirurgical sur la douleur et l’infertilité et modalités techniques. Quelles stratégies thérapeutiques? RPC Endométriose CNGOF-HAS [Minimal and mild endometriosis: Impact of the laparoscopic surgery on pelvic pain and fertility. CNGOF-HAS Endometriosis Guidelines]. Gynecol Obstet Fertil Senol 2018; 46: 273-7.
23. Ratan A, Pradhan S, Panigrahi PK, Sahu M, Peepal P, Das S. Role of laparoscopy in diagnosis and treatment of endometriosis associated with infertility: a prospective analysis. SMJ 2021: 73; 772–6.
24. Sun TT, Chen SK, Li XY, et al. Fertility outcomes after laparoscopic cystectomy in infertile patients with stage iii-iv endometriosis: a cohort with 6-10 years of follow-up. Adv Ther 2020; 37: 2159-68.
25. Thakral V, Garg S, Suren P. Evaluation of Endometriosis in Infertility: Incidence, Clinical Features, and Laparoscopic Findings. JMGUMST 2020: 5; 73-6.