Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia.

STUDY

OBJECTIVE

To describe a technique of uterine suspension using round ligaments to relieve pain in selected patients with various degrees of uterine retroversion.

DESIGN

Prospective clinical study (Canadian Task Force classification II-2).

SETTING

University-based center for reproductive medicine.

PATIENTS: Thirty women who underwent laparoscopy for investigation of chronic pelvic pain (CPP) and dyspareunia.

INTERVENTION: Round ligaments were plicated using a modification of intracorporeal knot tying during laparoscopy.

MEASUREMENTS AND MAIN

RESULTS

The extent of plication was planned to elevate the uterus and bring it minimally forward. Mean +/- SD operating time was 14+/-4 minutes. Pain scores before and after surgery were 4.5+/-1.0 and 1.6+/-0.6, respectively (p<0.001). There were no complications during or after surgery. Only three women had minimal dyspareunia postoperatively, although they had anteverted uteri. One patient had severe dyspareunia that developed 7 months after surgery and continued through the second year of follow-up. Nineteen women with anteverted uteri were free of dyspareunia after 2 years.

CONCLUSION

Round ligament plication is safe and effective in patients with retroverted uteri and dyspareunia or CPP.