World Journal of Laparoscopic Surgery

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VOLUME 17 , ISSUE 1 ( January-April, 2024 ) > List of Articles

Original Article

Hysteroscopy, an Essential Adjunct to Laparoscopy, in Evaluation of Women with Chronic Pelvic Pain

Vinita Sarbhai, Preeti

Keywords : Chronic pelvic pain, Diagnostic laparoscopy, Hysterectomy, Hysterolaparoscopy, Hysteroscopy, Laparoscopic surgery, Polyp, Uterine abnormality

Citation Information : Sarbhai V, Preeti. Hysteroscopy, an Essential Adjunct to Laparoscopy, in Evaluation of Women with Chronic Pelvic Pain. World J Lap Surg 2024; 17 (1):28-32.

DOI: 10.5005/jp-journals-10033-1597

License: CC BY-NC 4.0

Published Online: 14-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Introduction: Chronic pelvic pain (CPP) is a significant contributor to morbidity in women, accounting for 10–20% of all visits to gynecology outpatient department (OPD). Evaluating CPP remains a challenge due to its broad and multifactorial etiology. While laparoscopy is considered the gold standard for diagnosing CPP, it may overlook intrauterine causes. Hysteroscopy, on the other hand, provides an internal view for diagnosing intrauterine pathologies. Aim and objectives: This study aims to assess the role of hysteroscopy as a complementary procedure with laparoscopy in the evaluation of women with CPP. Materials and methods: This study was conducted at the Department of Obstetrics and Gynaecology in Kasturba Hospital, New Delhi, India. From January 2017 to March 2020, 50 women with CPP lasting more than six months underwent hysteroscopy in conjunction with laparoscopy. They were assessed for the causes of CPP and potential treatment options. Results: Hysteroscopy identified abnormalities in 24 (48%) of the patients. Among them, 9 (18%) had intrauterine adhesions, 6 (12%) had a partial septum, 4 (8%) had internal os stenosis, 4 (8%) had fibroids, 3 (6%) had polyps, and 2 (4%) had chronic pelvic inflammatory disease (PID) (with overlapping findings). These pathologies went undetected during laparoscopy. However, laparoscopy successfully diagnosed other intra-abdominal causes of CPP, including adhesions in 34%, endometriosis in 28%, chronic PID in 24%, fibroids in 12%, genital/abdominal Koch's in 6%, dermoid cysts, and other ovarian cysts in 4% each, and paraovarian cysts in 2%. In the same procedure, concurrent therapeutic interventions such as adhesiolysis (18%), cervical dilatation (8%), septal resection (6%), and polypectomy (4%) were performed using an operative hysteroscope. Conclusion: Hysteroscopy proved effective in identifying various intrauterine causes of CPP. It serves as a valuable adjunct to laparoscopy for diagnosing conditions affecting the cervix and uterine cavity, which can often coexist with the underlying causes of CPP.

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