Hernias as a cause of chronic pelvic pain in women.

BACKGROUND: Chronic pelvic pain in women due to hernias may be misdiagnosed by practicing clinicians. These fascial defects, their symptoms, physical findings, and proper treatment must be known in order to help women experiencing this form of chronic pelvic pain. METHODS: All procedures were performed by the primary author using standard laparoscopic tension-free mesh techniques. RESULTS: The study included 264 patients referred to a chronic pelvic pain clinic, who underwent 386 laparoscopic surgical repairs of hernial defects. Ninety percent of the patients underwent concomitant procedures appropriate for their multiple pain generators. Length of follow-up is 1.53 years (range, 2 months to 5.5 years). Evaluation of patients' pain component from the repaired hernia was recorded. There have been no recurrences. One persistent ilioinguinal neuropathy from an inguinal hernia repair (.4%) has occurred. All other patients received relief of their hernia pain (99.6%). Four complications from concomitant surgeries (1.5%) are reported. CONCLUSIONS: Laparoscopic treatment of hernia pain in women is effective in relieving chronic pain and has a low recurrence and complication rate in the hands of experienced laparoscopists.

Laparoscopic uterine suspension for pain relief: a multicenter study.

OBJECTIVE: To assess the efficacy of laparoscopic positioning by ligament investment, fixation and truncation (UPLIFT) in alleviating pain in women with a symptomatic, retroverted uterus, the duration of pain relief, and operative or postoperative complications associated with the procedure. STUDY DESIGN: Between May 22, 1998, and November 16, 2000, 62 women with a retroverted uterus, chronic pelvic pain, moderate to severe dysmenorrhea and/or dyspareunia underwent UPLIFT on an outpatient basis. The patients for this prospective, cohort study were recruited from 5 private gynecologic practices. The patients were asked to rate their pelvic pain, dysmenorrhea and dyspareunia on a scale of 0-10, with 0 no pain and 10 the worst pain imaginable, preoperatively and again at 4 weeks and 3, 6 and 12 months postoperatively. The average follow-up time was 10.2 months (range, 0.2-14.9). RESULTS: The mean scores for pelvic pain decreased from 7.3 to 3.7 at 12 months (n = 46). Dysmenorrhea decreased from 7.8 to 4.4 (n = 39), and dyspareunia decreased from 8.0 to 3.3 (n=41). All p values were <0.0001. There were 5 minor intraoperative adverse events. The procedure did not result in any postoperative complications. CONCLUSION: UPLIFT resulted in significant, long-term pain reduction in women with a symptomatic, retroverted uterus.

Diagnosis and laparoscopic repair of type I obturator hernia in women with chronic neuralgic pain.

BACKGROUND: We performed a pilot study review of 7 female patients suffering with obturator neuralgia produced by a type I obturator hernia. Diagnosis and laparoscopic treatment of this rare hernia are presented. METHODS: Patients with chronic pelvic pain and signs of obturator neuralgia were identified retrospectively by chart review. These patients had been referred to our chronic pelvic pain clinic. Outcomes of their surgery from February through November 2001 were analyzed. Median length of follow-up was 11 months (range, 6 to 16). A new technique using Cooper's ligament and arcus tendineus fasciae pelvis was used for the tension-free mesh hernia repair. RESULTS: In this pilot study, 6 of 7 patients (86%) received greater than 50% relief of their chronic pelvic pain, which leads to the conclusion that we have at least 95% confidence that the pain reduction achieved is greater that 50%. Due to the small sample size, no statistically meaningful conclusions could be reached. All of the patients have reported some pain relief and increased function since surgery. CONCLUSION: Symptomatic type I obturator hernias may be more common than previously thought. Patients with obturator neuralgia, persisting longer than 6 months despite conservative therapy, may respond to laparoscopic reduction of the pilot fat tag and mesh overlay of the obturator canal.