Review of effectiveness of LUNA and PSN in endometriosis surgery

31 May 2007

Systematic review of laparoscopic uterosacral nerve ablation (LUNA) and presacral neurectomy (PSN) shows the evidence for nerve interruption in the management of dysmenorrhea is limited

A review lead by Latthe et al at the University of Birmingham, UK, aimed to compare the two main surgical procedures available designed to cut sensory nerves in patients with dysmenorrhea. The two procedures that were evaluated and compared were ablation (removal) of the uterosacral nerve and removal of the presacral nerve.

Of the nine trials analysed in this study, two involved open presacral neurectomy while the others involved laparoscopic techniques. The two key details gathered in all the studies were the effectiveness of the operation on pain relief and the mildness or absence of side effects. The results are different for surgeries between primary and secondary dysmenorrhea. Primary dysmenorrhea is menstrual pain presented by women who are otherwise healthy. Secondary dysmenorrhea is pain associated with an underlying medical condition, such as in endometriosis.

All of the results were collected at twelve months after the surgery. Primary dysmenorrhea patients responded to surgery better than either no treatment or a control treatment; however responding better to presacral ablation than to laparoscopic uterosacral nerve ablation (LUNA). In secondary dysmenorrhea with inclusion of patients with endometriosis, it was found that LUNA did not provide further pain relief when combined with laparoscopic treatment of endometriosis. Patients did however respond better to laparoscopic treatment of endometriosis when combined with presacral ablation than to just laparoscopic treatment alone. Complications were more common in patients who underwent presacral ablation than surgeries that did not involve presacral ablation.

Dr Latthe concludes that the evidence for nerve interruption in the management of dysmenorrhea is limited and that methodologically sound and sufficiently powered randomized controlled trials are required in determining its efficacy in pain management in dysmenorrhea.

Review by: Eddie Ma

Source

Latthe PM, Proctor ML, Farquhar CM, Johnson N, Khan KS. Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness. Acta Obstet Gynecol Scand 2007;86(1):4-15.