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Ashon Sa’adi et al

surgical treatment of endometriosis-associated pelvic pain or 5. International association for the study of pain. Classification of
dysmenorrhea does not improve the outcome of surgical treat- chronic pain. Definitions of chronic pain syndromes and
ment. Although Chapron et al 1996 concluded LUNA/laparos- definitions of pain terms. Pain 1986;S1-S221.
copic surgery is efficient for the treatment of patients presenting 6. Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP.
painful symptoms related to deep endometriotic implants located Surgical interruption of pelvic nerve pathways for primary and
secondary dysmenorrhea. Cochrane Database Syst Rev. 2005
on the uterosacral ligaments. Patients who benefited from an Oct 19;(4)
improvement rated it excellent or satisfactory in over 80% of 7. SOGC Clinical Practice Guideline; Primary Dysmenorrhea
cases. 25 Soysal ME et al noted a significant reduction in total Consensus Guideline JOGC December 2005:1117-30
pelvic symptom score as compared from baseline with post- 8. David B Redwine, MD. Pelvic Reconstructive Surgery: Compli-
operative at the 3rd, 6th and 12th month (P < 0.001), also cations of LUNA and Presacral Neurectomy by Laparoscopy:
observed a significant improvement in Sabbatberg Sexual Rating http://laparoscopy.blogs.com/prevention_management/ 2005/ 12/
Scale as compared with baseline mean (SD) of 30.9 (4.3). The chapter_23_comp.html
mean difference (95% CI) of increase was 33.4 (30.3 ± 36.4), 33.2 9. Fujii M, Sagae S, Sato T, Tsugane M, Murakami G, Kudo R.
(30.1 ± 36.2) and 33.2 (30.1 ± 36.3) from the baseline at the 3rd, Investigation of the localization of nerves in the uterosacral
6th and 12th postoperative month that performed laparoscopic ligament: Determination of the optimal site for uterosacral nerve
ablation. Gynecol Obstet Invest 2002;54 Suppl 1:11-17.
presacral chemical neurolysis with phenol in 15 patients with 10. Stones W, Cheong YC, Howard FM. Interventions for treating
pelvic pain and minimal ± moderate endometriosis. 28 chronic pelvic pain in women. Cochrane Database Syst Rev.
The guidelines recommended the following: Presacral 2005;(2).
neurectomy may be considered for treatment of centrally located 11. Redwine DB, Perez JJ.; Laparoscopic presacral neurectomy. In
dysmenorrhea but has limited efficacy for chronic pelvic pain Soderstrom RA, ed; Operative Laparoscopy, The Masters’
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or pain that is not central in its location. Ablation of endo- Techniques 1993;157-60.
metriotic lesions plus laparoscopic uterine nerve ablation 12. Nezhat C, Nezhat F. A simplified method of laparoscopic
(LUNA) in minimal–moderate disease reduces endometriosis- presacral neurectomy for treatment of central pelvic pain due to
endometriosis. ; Br J Obstet Gynecol 1992;99:659-63.
associated pain at 6 months compared to diagnostic laparo- 13. Daniell JF. Fibreoptic laser laparoscopy. 1989;545-62.
scopy, the smallest effect is seen in patients with minimal disease. 14. Sutton C, Whitelaw N. Laparoscopic uterosacral nerve ablation
However, there is no evidence that LUNA is a necessary compo- for intractable dysmenorrhea. In Sutton C, Diamond M ed.
nent, as LUNA by itself, has no effect on dysmenorrhea asso- Endoscopic surgery for gynaecologists, 159-63. London: WB
ciated with endometriosis. 29,36 Saunders, 1993.
15. Latthe PM, Powell R, Daniels J, Hills RK, Gray R, GuptaJK,
CONCLUSION Khan KS. Variation in practice of laparoscopic uterosacral nerve
ablation: A European survey J Obstet Gynaecol 2004;24:
We have now showed that LUNA and PSN can be an option in 547-51.
a few circumstances, especially in primary or secondary 16. Latthe PM, Braunholtz DA, Hills RK, Khan KS, Lilford
menstrual pain without endometriosis. Finally, LUNA has not R. Measurement of beliefs about effectiveness of laparoscopic
been shown to reduce dysmenorrhea and, therefore, should uterosacral nerve ablation. BJOG 2005;112:243-46.
not be advocated as a mainstream treatment except who have 17. Thirlaway K, Fallowfield L, Cuzick J. The Sexual Activity
persistent dysmenorrhea despite medical therapy. Questionnaire: A measure of women’s sexual functioning.
Qual.Life Res. 1996;5:81-90.
18. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related
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