Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis

Abstract: Study Objective. To assess the long-term effectiveness of presacral neurectomy (PSN) in women with severe dysmenorrhea due to endometriosis treated with conservative laparoscopic surgical intervention.Design. Randomized, controlled trial (Canadian Task Force classification 1).Setting. University-affiliated department of obstetrics and gynecology.Patients. One hundred forty-one sexually active women of reproductive age.Intervention. Conservative laparoscopic surgery without (group A) or with (group B) PSN.Measurements and Main Results. At entry and 24-months after surgical procedures, cure rates; frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain; and quality of life were evaluated. At follow-up visit, the cure rate was significantly (P<0.05) higher in group B (83.3%) than in group A (53.3%). The frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain were significantly (P<0.05) lower in both groups compared with baseline values, and only severity was significantly (P<0.05) lower in group B. A significant (P<0.05) improvement in quality of life was observed after surgery in both groups and was significantly (P<0.05) increased in group B compared with group A.Conclusion. PSN improves long-term cure rates and quality of life in women treated with conservative laparoscopic surgery for severe dysmenorrhea due to endometriosis.