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