European Journal of Molecular & Clinical Medicine

Abstract

Introduction: Chronic pelvic pain is a symptom, not a disease, and rarely reflects a single pathologic process. When multiple factors are present, treatment of only some of them will lead to incomplete relief and frustration for both patient and clinician.
 
Aims and Objectives: To determine the role of Hystero-Laparoscopy for evaluation and management of Chronic Pelvic Pain.
 
Study Design: Prospective cross-sectional study conducted from July 2018 to May 2020 in 150 women with chronic pelvic pain more than 6 months durations in age group of 15-45 years.
 
Results: The mean age of patients was 26.23 ±10.12. The majority of patients were with parity 1-2 (41.33%) followed by nullipara (28%), parity 3-4 (25.33%) and parity >4 (5.34%) The majority of patients were pre-menopausal (59.33%) followed by post- menopausal (40.67%). Out of 150 patients, It was observed that majority of patients presented with Cyclic lower abdominal pain (61.33%) followed by dyspareunia (41.33%), acyclic lower abdominal pain (28%), congestive dysmenorrhea (24%) and spasmodic dysmenorrhea (18.67%).. It was observed that majority of patients had pelvic tenderness localized to fornix (58%) followed by diffuse tenderness (22.67%), Cul-de-sac nodularity (15.33%), fixed retroverted uterus (8%) and forniceal fullness (6%). Among 150 patients, around 25 (16.67%) showed no per-vaginal findings. According to laparoscopic findings, It was observed that majority of patients had endometriosis (27.33%) followed by Uterine fibroids (22.67%), Pelvic adhesions (19.33%), Ovarian pathology (15.33%) and PID (12%). Among 150 patients, around 9 (6%) showed normal findings by laparoscopy. According to diagnosis by hysteroscopic findings., It was observed that majority of patients had Polyp (35.33%) followed by Uterine fibroids (25.33%), Intra-uterine adhesion (20.67%) and Adenomyosis (17.33%). Among 150 patients, around 20 (13.33%) showed normal findings by hysteroscopy. The sensitivity of Laparoscopic investigation was 87.94%, specificity was 88.89%, and accuracy rate of 88% compared to pelvic findings. The relation of pelvic findings with combined Hystero-Laparoscopic finding showed sensitivity of combined Hystero-Laparoscopic investigation was 86.81%, specificity was 100%, and accuracy rate of 87.33% compared to pelvic findings. The sensitivity of combined Hystero-Laparoscopic investigation was 97.96%, specificity was 100%, and accuracy rate of 98% compared to final findings.
 
Conclusion: Hystero-Laparoscopy is an effective diagnostic and therapeutic tool, for evaluation of chronic pelvic pain, which are usually missed by other modalities.