Laparoscopy in the Chronic Pelvic Pain Patient: Incidence and Outcomes of Subsequent Laparoscopies

Study Objective: Our aim is to determine the incidence of multiple laparoscopies for chronic pelvic pain over 10 years and to compare outcomes between patients who underwent single vs multiple laparoscopies. Design: Retrospective case-control study. Setting: Urban based tertiary care medical center. Patients or Participants: Women with diagnosis of chronic pelvic pain that underwent one laparoscopy in comparison with those who underwent multiple laparoscopies in a 10-year period. Interventions: Multiple Laparoscopies. Measurements and Main Results: Parametric, nonparametric and descriptive statistics were employed. 792 patients were managed with laparoscopy for a diagnosis of chronic pelvic pain (CPP), 14% of which had multiple laparoscopies. 678 controls with single laparoscopy and 114 cases with multiple laparoscopies were identified. 400 (59%) had medical management prior to first laparoscopy in the control group and 82 (72%) in the cases. 559 had diagnostic and 119 had extirpative laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 extirpative laparoscopies in the multiple laparoscopy group. Of the patients with persistent pain after first laparoscopy in the control group, 52 underwent hysterectomy. Of the 37 who followed up, 26 reported pain response and 5 no response. The average number of laparoscopies in the multiple laparoscopy group was 2.27. In the multiple laparoscopy group, 38 patients underwent hysterectomy. Of the 26 that followed up, 22 reported pain response and 4 no response. Of the total patients who underwent hysterectomy and had follow-up, 80% (54 of 67) reported pain response. Of the 792 patients who underwent laparoscopy, 25 had pathologic evidence of endometriosis in the single laparoscopy group vs 32 in the multiple laparoscopy group. Conclusion: Approximately 1 in 7 patients are subject to multiple laparoscopies for CPP. Despite clinical symptoms, endometriosis is a minor contributor to CPP. Management of CPP with laparoscopy poorly correlates with response to hysterectomy