Adhesiolysis in Women with Chronic Pelvic Pain and a Temporal Resolution of Pain

Study Objectives: To evaluate the duration of pain improvement after laparoscopic and/or robotic assisted adhesiolysis in women with prior abdominal or pelvic surgeries that have been diagnosed with chronic pelvic pain with suspected pelvic and/or abdominal adhesions. Design: Retrospective Cohort (Canadian Task Force Level II) Setting: Hospital based practice of gynecological surgery and pelvic pain, St. Joseph Hospital and Medical Center, Phoenix AZ Patients: Women with prior surgery who underwent laparoscopic or robotic assisted adhesiolysis for chronic pelvic pain secondary to pelvic and/or abdominal adhesions between April 2012-Febuary 2016. Intervention; Adhesiolysis performed via laparoscopic or robotic assisted, defined as 30 minutes or greater of operating time needed to restore normal anatomy. Measurements and Main Results: Eighty-eight women were identified with Current Procedural Terminology (CPT) code 4410 and 58550 for adhesiolysis. Women > 18 years old who had prior surgery, and symptoms of pelvic pain were included in the study. Women were excluded if they were found to have another source of pelvic pain, malignancy, surgical complications, co-surgery with another specialty, and conversion to laparotomy, and organ resection. The average age at the time of adhesiolysis was 39 years old (range of 19-57). The average number of abdominal surgeries was 1.42 (range 1-4). Fifty-six patients were excluded for concomitant procedures. Thirty-patients patients meet eligibility criteria, of those; seventeen patients had previously undergone at least one adhesiolysis procedure for the treatment of chronic pelvic pain. All 17 of these patients had improvement of their pain. Fourteen of the 17 patients had 2 adhesiolysis procedures with the median length of time between the first and second procedure (improvement in pain after procedure) being 24 months (range of 6-162 months). Three of 14 underwent a third adhesiolysis procedure with the median pain free interval of 24 months. Two of the 3 patients had a fourth adhesiolysis procedure with the average pain free interval being 24 months prior to the 4th procedure. Fifteen of the 32 patients, who underwent their first adhesiolysis treatment, 10 had resolution of pain and 5 patients had a significant improvement of pain. Of this cohort the earliest reported return of pain was 6 months, and the longest total pain free interval was 13 years and 6 months. Conclusion: In patients who present with pelvic pain and prior abdominal or pelvic surgery adhesiolysis may be associated with a temporal improvement of pain.