RESUMEN
OBJECTIVE: To determine the prevalence of occult microscopic endometriosis in patients with chronic pelvic pain and negative laparoscopy. METHODS: A retrospective cross-sectional study included women who underwent laparoscopic evaluation for chronic pelvic pain by three fellowship-trained gynecologic surgeons at a community hospital from January 2011 to December 2016. The aim was to evaluate the prevalence of microscopic endometriosis in this population. RESULTS: In 142 patients with clinically negative peritoneum on laparoscopy, 39% had occult microscopic endometriosis. Cramping pain score during menses was found to be lower in the positive biopsy group (6.9 vs 8.0, P=0.046). No differences were appreciated in age of menarche, pain during various parts of the menstrual cycle, or duration of symptoms. The biopsy-positive group had a younger age at time of evaluation, although not statistically significant (P=0.179). Current use of hormones affected neither biopsy results nor menstrual or pain characteristics. Detection was similar between robotic and laparoscopic cases and operative morbidity was minimal. CONCLUSION: Occult microscopic endometriosis may be present in approximately 39% of patients with clinically negative appearing peritoneum undergoing laparoscopy for chronic pelvic pain. Given this, biopsies should be performed in patients undergoing laparoscopy who do not have visible lesions.
Asunto(s)
Endometriosis/epidemiología , Peritoneo/patología , Adulto , Arizona/epidemiología , Dolor Crónico/etiología , Estudios Transversales , Endometriosis/complicaciones , Femenino , Humanos , Laparoscopía , Dimensión del Dolor , Dolor Pélvico/etiología , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE OF REVIEW: The purpose of this publication is to review the currently available and most up-to-date information regarding the pathogenesis, diagnosis, and treatment of pelvic congestion syndrome. RECENT FINDINGS: The diagnosis of pelvic congestion syndrome is difficult to make; however, it should remain on the differential for chronic pelvic pain. The most recent available research seems to favour endovascular treatment with interventional radiology over surgical management, with high success rate and low occurrence of complications. SUMMARY: High-level evidence on the diagnosis and management of pelvic congestion syndrome is lacking. Only a small number of randomized controlled trials exist. More high-quality research is needed, particularly involving practicing obstetrician and gynecologists as the majority of these patients, and the clinical outcomes of any interventions implemented for pelvic congestion syndrome are ultimately managed by OB/GYN providers.
Asunto(s)
Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Dolor Pélvico/diagnóstico , Dolor Pélvico/terapia , Dolor Crónico/fisiopatología , Femenino , Ginecología/métodos , Humanos , Obstetricia/métodos , Dolor Pélvico/fisiopatología , SíndromeRESUMEN
BACKGROUND: When tubal ligations cannot be performed because of dense postoperative adhesions, options for female sterilization are very limited. As the incidence of cesarean delivery rises and the occurrence of peritubal adhesions increases, tubal ligation using abdominal or laparoscopic surgery may become increasingly technically difficult. Hysteroscopic tubal occlusion provides a method of permanent sterilization when an abdominal or laparoscopic approach is unsuccessful. CASES: Three patients with failed tubal ligations by abdominal or laparoscopic approaches were referred to our institution. Their cases were complicated by technically difficult surgeries with dense intraabdominal adhesions. Hysteroscopic tubal occlusion was successfully performed in each patient. CONCLUSION: Hysteroscopic tubal occlusion can be used for permanent sterilization when abdominal or laparoscopic approaches are not possible.