Presacral
neurectomy has been advocated for severe
dysmenorrhea when medical
therapy fails to provide adequate relief. However, there are concerns regarding efficacy and the potential for postoperative complications. In order to address these concerns, questionnaires were used to assess the levels of
pain (0-5 scale) before and after laparoscopic ablation/excision of
endometriosis, which in some patients included a presacral
neurectomy. Patients completed a preoperative and
postoperative pain assessment to rate
pain at different parts of the menstrual cycle, bowel symptoms, bladder symptoms, and general level of function. To date we have evaluated the records of 371 control patients (CON) and 76 patients who underwent a presacral
neurectomy (PSN). Similar proportions of patients in each group were distributed among the different stages of
endometriosis: Stage I, 25% (CON), 38% (PSN); Stage II, 28%/29%; Stage III, 31%/24%; Stage IV, 17%/10%. Significant improvement (by Wilcoxon signed rank test) over preoperative
pain levels was found in both groups for menstrual
cramps as well as other symptoms related to
endometriosis. Even when controlled for preoperative
pain level, comparable degrees of
pain relief were observed in both groups. These results indicate that presacral
neurectomy has no substantial benefit for the relief of
dysmenorrhea over laparoscopic ablation/excision alone.