The Incidence of Negative Laparoscopy for Pelvic Pain Stratified by Level of Training and Location of Service Provision.

AIM: Systematic reduction of negative laparoscopy for pelvic pain is crucial to reducing surgical morbidity, improving diagnostic accuracy and minimising cost. This study aims to determine the incidence and consider the underlying causes of negative laparoscopy in women presenting with pelvic pain.

METHODS

A 5-year, retrospective cohort study was undertaken for women undergoing laparoscopy for pelvic pain. Patient selection was from an Australian tertiary public hospital with both non-fellowship trained gynaecologists and an Australasian Gynaecological Endoscopic Surgery (AGES) accredited training programme (fellowship trained) as well as one private clinic comprising two fellowship trained gynaecologists. Data was collected from the medical records. A 'negative' laparoscopy was defined either visually or by vision and negative biopsy on histology. The rate of negative laparoscopy in the public and private sector was compared using an odds ratio.

RESULTS

Of 1309 women, 174 (13%) had a negative laparoscopy. The negative laparoscopy rate was significantly higher amongst non-fellowship trained gynaecologists compared to those with fellowship training (OR = 2.48; 95% CI: 1.76-3.43, p < 0.05). Visually negative laparoscopy was made in 48/174 (28%) of cases, all from the public sector, with 41/48 (85%) of laparoscopies without biopsy performed by non-fellowship trained gynaecologists. A 56% discordance between intraoperative visualisation and histopathological findings was identified.

CONCLUSION

Overall, negative laparoscopy rates are low compared to previously reported data. The discrepancy between the healthcare sectors likely relates to patient factors, surgical training, and clinician bias. Peritoneal biopsy for symptomatic patients undergoing laparoscopy should be considered due to the potential to miss superficial disease.