Comparison of a new modified laparoscopic presacral neurectomy and conventional laparoscopic presacral neurectomy in the treatment of midline dysmenorrhea

Objective: To describe a newly modified laparoscopic presacral neurectomy procedure and to evaluate the long-term benefits of the surgery as a treatment for midline dysmenorrhea. Method: Eighty-eight reproductive female patients with midline dysmenorrhea were enrolled in the non-randomized prospective study. There were fifty-five patients in the modified laparoscopic presacral neurectomy (MLPSN) group and thirty-three patients in the conventional laparoscopic presacral neurectomy (LPSN) group. All patients received post-surgery follow-up of more than eight years for evaluation with respect to pain relief, recurrence, and complications. Results: Upon receipt of surgery, the MLPSN and the LPSN groups both demonstrated a significant decrease (P < 0.001) in the mean pain score when compared to the pre-surgery mean pain scores. However, the probability of recurrence during the eight years of follow-up was 81.8% (27 patients) in the LPSN group, compared to 43.6% (24 patients) in the MLPSN group, resulting in a significantly lower long-term recurrence rate in the MLPSN group, compared to the LPSN group (P < 0.05). No patients in the MLPSN group had long-term complications and one patient had constipation after surgery in the LPSN group. Conclusion: The modified laparoscopic presacral neurectomy procedure provides an alternative for those patients who suffer intractable midline dysmenorrhea. This surgery is relatively simple and safe and could result in a satisfactory long-term outcome in the intervention of midline dysmenorrhea.