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Surgical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
A trial of presacral neurectomy combined with endometriosis treatment versus endometriosis treatment alone showed that there was an overall improvement in pain relief. The data suggest that this may be specific for midline abdominal pain only. Adverse events were significantly more common for presacral neurectomy, but the majority were constipation, which may improve spontaneously14.
Pain management
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Andrew Lawson, Paul Farquhar-Smith
Presacral neurectomy has been used for the control of intractable pelvic pain, whether due to malignancy or chronic pelvic pain syndromes. The technique involves the division of the superior hypogastric plexus at the L5/S1 region as described above. The presacral nerves can be divided as an open procedure or via the laparoscope. Laparoscopic presacral neurectomy is probably the technique of choice (Figures 40.5 and 40.6). Bowel preparation may be useful preoperatively to decompress the bowel. Under direct vision, an incision is made in the peritoneum over the lateral sacral promontory and dissecting forceps are used to dissect out the hypogastric plexus. It may then be ligated, cut, or cauterized (Figure 40.7).
Chronic pelvic pain
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Presacral neurectomy involves transection of the superior hypogastric plexus at the level of the sacrum. This differs from uterosacral transection (laparoscopic uterine nerve ablation (LUNA)) in which the nerves are cut at the level of the uterus. LUNA involves the destruction of the uterine nerve fibers as they exit the uterus through the uterosacral ligament.
Surgical challenges in the treatment of perimenopausal and postmenopausal endometriosis
Published in Climacteric, 2018
E. S. Ozyurek, T. Yoldemir, U. Kalkan
Prior to any surgery for supposed recurrence, irritable bowel syndrome, interstitial cystitis, myofascial and vertebral pathologies should be ruled out and the patient warned of potential complications of radical surgery22,55–59. Presacral neurectomy or lower uterine nerve ablation do not have any additional benefit in decreasing persistence rates of postoperative symptoms and may cause chronic constipation and bladder dysfunction60.
Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: an open-label pilot clinical trial
Published in Journal of Obstetrics and Gynaecology, 2021
Sepideh Khodaverdi, Mahmoud Reza Alebouyeh, Kambiz Sadegi, Abolfazl Mehdizadehkashi, Mania Kaveh, Saeid Reza Entezari, Hossein Mirzaei, Mojdeh Khaledi, Maryam Khodaverdi
Laparoscopic presacral Neurectomy has been extensively investigated as an effective technique for the treatment of chronic pelvic pain in endometriosis and dysmenorrhoea (Kwok et al. 2001; Soysal et al. 2003). However, laparoscopic presacral neurectomy is an elective operation requiring surgical skills and expertise. Moreover, it may be associated with vascular and lymphatic complications due to the vicinity of great vessels and lymphatic channels (Chen and Soong 1997).