World Journal of Laparoscopic Surgery

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VOLUME 1 , ISSUE 3 ( September-December, 2008 ) > List of Articles

RESEARCH ARTICLE

The Role of Laparoscopic Uterine Nerve Ablation (LUNA) and Presacral Neurectomy (PSN) of Pelvic Pain Management

Ashon Sa'adi

Citation Information : Sa'adi A. The Role of Laparoscopic Uterine Nerve Ablation (LUNA) and Presacral Neurectomy (PSN) of Pelvic Pain Management. World J Lap Surg 2008; 1 (3):39-45.

DOI: 10.5005/jp-journals-10007-1069

Published Online: 00-12-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

The chronic pelvic pain as non-cyclical pain is serious enough to cause disability or lead to medical care. While these treatments are very successful there is still a 20 to 25% failure rate and surgery has been an option for such cases. Effectiveness of laparoscopic uterosacral nerve ablation (LUNA) and presacral neurectomy (PSN) can be useful for alleviating chronic pelvic pain.

Objectives

To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrheal in the chonic pelvic pain.

Data sources

Various watchfulness sources related to surgically chronic pelvic pain treatment from various causes and journals, also involve the Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials.

Methods

Review and analyzed of prospective study of laparoscopy presacral neurectomy/PSN or laparoscopy uterosacral nerve ablation/LUNA (both open and laparoscopic procedures) for the treatment of pelvic pain (primary and secondary dysmenorrheal). The main outcome measures were pain relief and adverse effects.

Results

We have got 13 sources analysis extracted data on characteristics of the study quality and the population, intervention, and outcome independently. Nine randomized controlled trials were included in the systematic review. There were two trials with open presacral neurectomy; all other trials used laparoscopic techniques. For the treatment of primary dysmenorrhea, laparoscopic uterosacral nerve ablation at 12 months was better when compared to a control or no treatment. The comparison of laparoscopic uterosacral nerve ablation with presacral neurectomy for primary dysmenorrhea showed that at 12 months follow-up, presacral neurectomy was more effective. In secondary dysmenorrhea, along with laparoscopic surgical treatment of endometriosis, the addition of laparoscopic uterosacral nerve ablation did not improve the pain relief, while comparing to presacral neurectomy. Side effects were more common for presacral neurectomy than procedures laparoscopy uterine nerve ablation.

Conclusion

Currently, we have showed that LUNA and PSN can be an option in primary or secondary menstrual pain without endometriosis; LUNA has not been shown to reduce dysmenorrhea and, therefore, should not be advocated as a mainstream treatment except who have persistent dysmenorrhea.


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