Original Article - Role of laparoscopy in evaluation of chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is a common medical problem \naffecting women. Too often the physical signs are not specific. This \nstudy aims at determining the accuracy of diagnostic laparoscopy over \nclinical pelvic examination. Settings and Design: A retrospective \nstudy of patients who underwent diagnostic laparoscopy for CPP. \nMaterials and Methods: The medical records of 86 women who underwent \nlaparoscopic evaluation for CPP of at least 6-month duration were \nreviewed for presentation of symptoms, pelvic examination findings at \nthe admission, operative findings and follow up when available. \nStatistical analysis used: McNemar Chi-square test for frequencies in a \n2 x 2 table. Results: The most common presentation was acyclic lower \nabdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). \n61.6% of women did not reveal any significant signs on pelvic \nexamination. Pelvic tenderness was elicited in 27.9%. Diagnostic \nlaparoscopy revealed significant pelvic pathology in 58% of those who \nessentially had normal pervaginal findings. The most common pelvic \npathology by laparoscopy was pelvic adhesions (20.9%), followed by \npelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain \nrelief only in one-third of the women.\tConclusion: The study revealed \nvery low incidence of endometriosis (4.7%). Overall clinical \nexamination could detect abnormality in only 38% of women, where as \nlaparoscopy could detect significant pathology in 66% of women with \nCPP. This shows superiority of diagnostic laparoscopy over clinical \nexamination in detection of aetiology in women with CPP (P < 0.001). \nAdhesiolysis helps only small proportion of women in achieving pain \ncontrol.