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Should women with chronic pelvic pain have adhesiolysis?

Should women with chronic pelvic pain have adhesiolysis?
Should women with chronic pelvic pain have adhesiolysis?
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
36
Cheong, Y.C.
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Reading, Isabel
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Bailey, Sarah
e7d4c252-a377-4817-a883-019bb172c00c
Sadek, Khaled
d4c1b666-b9e3-4b69-a382-c6db71640541
Ledger, W.
a6eb6da0-1fbc-4170-8576-a9ffe767cc87
Li, T.C
043c8ccb-0984-4d36-bc4b-ffb5de6fcab2
Cheong, Y.C.
4efbba2a-3036-4dce-82f1-8b4017952c83
Reading, Isabel
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Bailey, Sarah
e7d4c252-a377-4817-a883-019bb172c00c
Sadek, Khaled
d4c1b666-b9e3-4b69-a382-c6db71640541
Ledger, W.
a6eb6da0-1fbc-4170-8576-a9ffe767cc87
Li, T.C
043c8ccb-0984-4d36-bc4b-ffb5de6fcab2

Cheong, Y.C., Reading, Isabel, Bailey, Sarah, Sadek, Khaled, Ledger, W. and Li, T.C (2014) Should women with chronic pelvic pain have adhesiolysis? BMC Women’s Health, 14, 36. (doi:10.1186/1472-6874-14-36).

Record type: Article

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

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Published date: 4 March 2014
Organisations: Primary Care & Population Sciences, Human Development & Health

Identifiers

Local EPrints ID: 362707
URI: https://eprints.soton.ac.uk/id/eprint/362707
PURE UUID: 3aa05b82-19ec-43db-a02e-811911775f9c
ORCID for Y.C. Cheong: ORCID iD orcid.org/0000-0001-7687-4597
ORCID for Isabel Reading: ORCID iD orcid.org/0000-0002-1457-6532

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Date deposited: 07 Mar 2014 09:16
Last modified: 07 Aug 2019 00:47

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Contributors

Author: Y.C. Cheong ORCID iD
Author: Isabel Reading ORCID iD
Author: Sarah Bailey
Author: Khaled Sadek
Author: W. Ledger
Author: T.C Li

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