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Open Access Research article

Should women with chronic pelvic pain have adhesiolysis?

Ying C Cheong12*, Isobel Reading5, Sarah Bailey1, Khaled Sadek1, William Ledger4 and Tin C Li3

Author Affiliations

1 Human Development and Health, Faculty of Medicine, University of Southampton, Coxford Road, Southampton SO16 5YA, UK

2 Complete Fertility Centre Southampton, Princess Anne Hospital, Coxford Road, SO16 5YA Southampton, UK

3 Royal Hallamshire Hospital, Jessop Wing, Tree Root Walk, S10 2 SF Sheffield, UK

4 University of New South Wales, UNSW, Sydney, NSW 2052, Australia

5 Research Design Service, Southampton General Hospital, Coxford Road, SO16 5YA Southampton, UK

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BMC Women's Health 2014, 14:36  doi:10.1186/1472-6874-14-36

Published: 4 March 2014

Abstract

Background

Pelvic adhesions are found in up to 50% of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions, and the clinical benefit of adhesiolysis in the context of CPP is still unclear. Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP) and adhesions.

Methods

This was a double-blinded RCT. This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4 years. Women with chronic pelvic pain (CPP) were randomized into having laparoscopic adhesiolysis or diagnostic laparoscopy. Women were assessed at 0, 3 and 6 months for Visual analogue scale scores (VAS) and Quality of Life (QoL) measures (SF-12 and EHP-30).

Results

A total of 92 participants were recruited; 50 qualified to be randomized, with 26 in the adhesiolysis and 24 in the control group. The results are expressed in median (interquartile ranges). In women who underwent adhesiolysis, there was a significant improvement at 6 months in VAS scores (-17.5 (-36.0 - -5.0) compared to controls (-1.5 (-15.0 – 4.5; p = 0.048); SF-12 scores physical component score (25.0 (18.8 – 43.8)) compared to controls (6.3 (-6.3 – 18.8); p = 0.021), SF-12 emotional component score 32.5 (4.4 – 48.8) compared to controls -5 (-21.3 – 15.0); p < 0.0074) and EHP-30 emotional well being domain 32.5 (4.4 – 48.8) compared to the controls -5 (-21.3 – 15.0; p < 0.0074).

Conclusions

This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding. In selected population of women presenting to the gynecological clinic with chronic pelvic pain, adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life.

Trial registration number

ISRCTN 43852269

Keywords:
Chronic pelvic pain; Adhesiolysis; Surgery; Laparoscopy; Randomised controlled trial