Laparoscopic evaluation of female factors in infertility.
- Nousheen Aziz
- Journal of the College of Physicians and Surgeons…
Chronic pelvic pain (CPP) is best defined as pain localized to pelvis or lower abdomen below the line joining the two anterior superior iliac spines, and of at least six months duration which is severe enough to cause functional disability and requires medical or surgical treatment (1). Chronic pelvic pain accouts for 10% of office visits to gynecologists and general clinics (2). It is responsible for 40% of laparoscopies and 10-15% of hysterectomies in this country. The causes of CPP are often obscure. Patients with CPP are frequently anxious, depressed and distressed. Though a good gynecologist may obtain considerable information by clinical examination alone, it is not conclusive in many patients. Hence there arises a need for imaging the pelvic organs by USG or for direct visualization of pelvic organs by laparoscopy. Sensitivity of ultrasonography for evaluation of CPP is poor. Till date, laparoscopy has been the gold standard in diagnosis and evaluation of CPP (3). It is an extremely valuable adjunct in gynecologist's armamentarium especially in confirming minimal diseases and adhesions. The placebo effect of diagnostic laparoscopy in women with the absence of pathology on visualization has been reported (4). The preset study was undertaken to find out the role of laparoscopy in evaluation of chronic pelvic pain and to correlate laparoscopic findings with the pre operative pelvic findings in patients of CPP. Material & Methods The present study was conducted in the department of Obstetrics and Gynecology S.M.G.S. hospital, Govt. Medical College, Jammu over a period of one year (Dec 2008 Nov 2009). Cases were selected from the out patient department and those who were admitted in Gynaecology ward. Detailed history was taken including associated symptoms like abnormal vaginal bleeding or discharge, dysmenorrhea, dyspareunia, infertility, enterocolic , urologic and musclo skeletal symptoms. After recording history, clinical examination and routine investigation, USG was done. Patients with obvious nongynecologic etiology like enterocolic, urologic or musculo skeletal causes were excluded. The study cases (52) were subjected to diagnostic laparoscopy after ruling out exclusion criteria for laparoscopy i.e. extreme obesity, cardiac and respiratory diseases, Diaphragmatic hernia and very large intra abdominal masses (>24wks gestation size) Abstract The present study was undertaken to find out the role of laparoscopy in evaluation of chronic pelvic pain and to correlate laparoscopic findings with preoperative pelvic findings. Fifty-two women with pelvic pain of more than 6 months duration were included. They were examined clinically and then subjected to Transabdominal sonography and laparoscopy. Of 52 patient's enrolled for study, 51.92% of patients were in the age group of 21-30 years with equal number of cases from rural and urban areas. Abnormal menstrural cycle patterns were seen in 32.70% of patients with menorrhagia contributing 23.07%. 44.24% patients had abnormal pelvic findings on preoperative pelvic examination. Ultrasonography could detect abnormality in 32.70% of patients as compared to Laparoscopy which had abnormal findings in 75%. Most common pelvic pathology was PID in 26.92% followed by adhesions in 12.07% cases which could not be detected clinically and on sonography. Laparoscopy is a more sensitive and superior method for evaluation of chronic pelvic pain as compared to ultrasonography. Laparoscopy can establish a definitive diagnosis, modify and provide treatment without resorting to exploratory laparotomy .