Presacral neurectomy--a reappraisal.

Between April 1984 and April 1990, 20 patients with a mean age of 27.9 years underwent presacral neurectomy at The Royal Women's Hospital, Melbourne, Australia. Overall, 11 of the 19 patients (58%) assessable for follow-up were totally cured of pain and 8 (42%) were partially cured. The most common indication for presacral neurectomy was secondary dysmenorrhoea, usually in association with endometriosis or pelvic adhesions. In 4 patients with uterine dysmenorrhoea not associated with pelvic pathology the operation produced a complete cure. The general consensus of gynaecological opinion is that presacral neurectomy should still be reserved for a limited number of carefully selected patients in whom other methods of treatment have been exhausted. It is imperative that a prior psychological assessment should be undertaken whenever a functional component is suspected. Whilst pain of uterine origin may be cured by presacral neurectomy, lateral pelvic pain of adnexal origin requires ovarian sympathectomy.