Presacral neurectomy for Endometriosis

Overview
Presacral neurectomy is a surgery to cut or interrupt the nerves that connect the uterus to the brain to relieve pain associated with endometriosis.

What does it involve?
Take time choosing your surgeon and hospital. Ask each surgeon you consider how many presacral neurectomies they have performed, and what their rates of success are. Find out details about your surgical options, the procedure involved, recovery time, and the risks and benefits associated with presacral neurectomy.

Presacral neurectomy may be performed during another surgery, such as excision. If it is performed during another surgery, presacral neurectomy is usually the final procedure performed. One benefit to receiving presacral neurectomy during another surgery is that it is not necessary to receive additional incisions. As a stand-alone surgery, presacral neurectomy can be performed through either laproscopy or laparotomy.

During a presacral neurectomy, the surgeon cuts or destroys the nerves that carry pain signals to the brain. The nerves are located near major blood vessels and the right ureter (the tube that carries urine from the kidney to the bladder). The surgeon must be highly experienced and skilled to perform a presacral neurectomy safely.

Intended Outcomes
A presacral neurectomy is performed to reduce pain associated with endometriosis.

Results
A 2007 article reviewed the results of nine clinical trials studying the effectiveness and safety of presacral neurectomy and uterosacral nerve ablation for dysmenorrhea (painful periods). Researchers concluded that there was insufficient evidence to support either procedure and recommended that more studies are needed.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, scarring, reactions to medication, and heart attack or stroke during the surgery. Short-term complications of surgery for endometriosis can include pain in the surgical area, constipation, diarrhea, bladder or vein irritation, nausea, vomiting, fatigue, nightmares, trouble sleeping, headaches, and shoulder pain from gas trapped beneath the diaphragm. Long-term complications can include scarring and adhesions, both of which can affect fertility and necessitate additional surgeries.

Specific risks associated with presacral neurectomy surgery include urinary and gastrointestinal side effects including constipation and bladder urgency. These side effects may or may not improve in time.

Call your doctor if you notice symptoms of infection such as fever, bleeding, swelling, or increased pain at the incision, or severe abdominal cramping and pain. Notify your doctor if you experience chest pain, shortness of breath, discharge from the wound, abnormal or foul-smelling vaginal discharge, pain or swelling in your calves, painful or frequent urination, or vomiting more than 24 hours after the surgery.

If you have a presacral neurectomy, you may not feel labor pains from subsequent pregnancies. If you become pregnant after having a presacral neurectomy, inform your obstetrician so they can monitor you for signs of labor as you approach your due date.

Presacral neurectomy may not be effective in relieving your pain from endometriosis.

The nerves cut or destroyed during presacral neurectomy may eventually regrow, causing your pain to return.