A PROSPECTIVE STUDY ON THE EFFICACY OF THE LAPAROSCOPIC UTEROSACRAL NERVE ABLATION (LUNA) IN THE TREATMENT OF CHRONIC PELVIC PAIN

DR. ARGHYA MAITRA; DR. PRIYADARSHI KUNDU; DR. ATISH DIPANKAR METYA; DR. MATIUR HOQUE

Volume : VIII, Issue : XI, November - 2019

A PROSPECTIVE STUDY ON THE EFFICACY OF THE LAPAROSCOPIC UTEROSACRAL NERVE ABLATION (LUNA) IN THE TREATMENT OF CHRONIC PELVIC PAIN

Dr. Arghya Maitra, Dr. Priyadarshi Kundu, Dr. Atish Dipankar Metya, Dr. Matiur Hoque

Abstract :

BACKGROUND: CPP is defined as constant or intermittent cyclic or acyclic pain that persist for 6 months or more and includes dysmenorrhea and intermenstrual pain.The Lee–Frankenhauser sensory nerve plexuses and parasympathetic ganglia in the uterosacral ligaments carry pain from the uterus ,cervix and other pelvic structures. Interruption of these nerve trunks by Laparoscopic Uterosacral Nerve Ablation (LUNA ) may alleviate pain. AIMS & OBJECTIVE: To assess the effectiveness of the laparoscopic uterosacral nerve ablation (LUNA) in case of a woman with chronic pelvic pain in whom diagnostic laparoscopy reveals either no pathology or mild endometriosis (American fertility society score < 5) (principal objective). MATERIALS & METHODS: A prospective observational study conducted in the Department of Obstetrics and Gynaecology, Calcutta National Medical College, Kolkata, over 30 women out of 127 who have presented with CPP of >6 months duration during the period MARCH 2018 to AUGUST 2019. The subjects were selected according to inclusion and exclusion criteria of this study. Patients were assessed by Specific history characteristics, pre–operative ultrasound examination and findings. In all women, diagonostic laparoscopy and LUNA was performed under general anesthesia. RESULTS: The incidence of CPP in present study was found 12.11%. The majority (66.7%) of the patients with CPP were in sexually active age group ranges between 26 – 35 years, 46.7% of patients were nulliparous and 86% were married. The most frequent finding on laparoscopy was endometriosis (36.7%) in various pelvic sites. Overall success rate of LUNA after 3 months, 6 months and 12 months followup –80%,76.7% and 70% respectively. CONCLUSION: Laparoscopy is the gold standard investigation for evaluation of patients with CPP as it enables not only confirmation of clinical or sonographic findings but also detects causes of pain in many. LUNA can be a alternative option in well selected patients for control of CPP with mild endometriosis, dysmenorrhoea, dyspareunia and chronic PID.