Surgery for chronic pelvic pain

Surgery Overview

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Laparotomy is a surgical procedure that is done by making an incision in the lower abdomen. This allows the surgeon to see and inspect the abdominal cavity for structural problems, sites of endometriosis (implants), and scar tissue (adhesions). The surgeon can then remove implants and adhesions. The surgeon can also correct structural problems that interfere with an organ's normal function, such as removing adhesions from the bowel wall.

Many of the procedures that required a laparotomy in the past can now be done with laparoscopy, which uses a smaller incision. Ask your surgeon why laparotomy is required.

What To Expect After Surgery

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• General anesthesia is usually used.
• The hospital stay varies from 2 to 4 days.
• You will usually be able to return to normal activities in 3 to 4 weeks.

Why It Is Done

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Laparotomy is indicated for moderate to severe chronic female pelvic pain when:

• Sites of endometriosis (implants) and scar tissue (adhesions):
  • Cannot be removed by laparoscopy.
  • Are interfering with the normal function of other abdominal organs, such as the bowels or bladder.
• A large ovarian cyst is present and scar tissue has formed around the cyst and a fallopian tube.
• There is concern that an ovarian cyst might indicate the presence of ovarian cancer.

A laparotomy is usually required to remove:

• Sites of endometriosis (implants) and scar tissue (adhesions) that:
  • Bind one segment of bowel to another segment or to other structures in the pelvis.
  • Have penetrated deeply into an abdominal organ and cannot be safely removed by laparoscopy.
• Large sites of scar tissue (adhesions).
• Nerves, for pain control (presacral neurectomy).

How Well It Works

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Surgery for chronic female pelvic pain should be limited to the treatment of surgically correctable problems. There is no evidence that surgical removal of the reproductive organs relieves chronic pelvic pain. It may even make the pain worse.¹

Risks

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• Pain may not be controlled or may get worse.
• Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis.

What To Think About

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Laparotomy may be needed when scar tissue binds abdominal organs, impairing their function. However, a laparotomy may cause more scar tissue to form.

There is no evidence that surgical removal of the reproductive organs relieves chronic pelvic pain.²

It is important that your surgeon understands your treatment goals. Be sure you discuss your goals, such as the desire for future pregnancies. If fertility is not your primary treatment goal, a decision could be made to remove one or both ovaries, one or both fallopian tubes, or the uterus during a laparotomy.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Mishell DR Jr, et al. (2001). Differential diagnosis of major gynecologic problems by age groups. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 155–176. St. Louis: Mosby.

2. Reiter RC (1998). Evidence-based management of chronic pelvic pain. Clinical Obstetrics and Gynecology, 41(2): 422–435.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	January 30, 2007