An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for chronic pelvic pain.

We evaluated the outcome of microsurgical (n = 72) and laparoscopic (n = 51) adhesiolysis in women who complained of chronic pelvic pain. Adhesion severity was not significantly different between the two treatment groups. The influences of the following variables on the outcome of all 123 cases of adhesiolysis were examined: (i) surgical modality (microsurgical or laparoscopic), (ii) history of infertility, (iii) associated dyspareunia and (iv) aetiological factors of adhesive disease (endometriosis, pelvic inflammatory disease and previous laparotomy). To adjust for differences in follow-up intervals, overall and subgroup cumulative rates of pain persistence/recurrence were calculated and compared. To adjust for interrelationships between variables and to correct fo differences between the treatment groups, a proportional hazards regression analysis was employed. This analysis showed that the cumulative rate of pain persistance/recurrence at 24 months was not significantly different after microsurgical (44%) and laparoscopic (53%) adhesiolysis. From all the variables which were examined, the only one which appeared to influence the impact of surgical adhesiolysis for chronic pelvic pain was a history of previous laparotomy. A history of previous laparotomy was associated with approximately three times higher rates of pain persistence or recurrence. This effect did not depend on whether previous laparotomy was carried out for pain or for other indications. The most likely explanation for the failure of these patients who had a previous laparotomy to respond to surgery is that they intrinsically have a higher rate of adhesion formation and reformation. This can only be confirmed with a prospective study where all patients will undergo a second-look laparoscopy.