Presacral neurectomy is one of the treatments for chronic pelvic pain and

dysmenorrhea Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the ...

. Lapraroscopic presacral neurectomy is an initial surgical intervention for chronic pelvic pain when medical therapy fails. __TOC__

Mechanism

The sensory pathways from the pelvic viscera pass through the

superior hypogastric plexus The superior hypogastric plexus (in older texts, hypogastric plexus or presacral nerve) is a plexus of nerves situated on the vertebral bodies anterior to the bifurcation of the abdominal aorta. Structure From the plexus, sympathetic fibers are ca ...

and

inferior hypogastric plexus The inferior hypogastric plexus (pelvic plexus in some texts) is a network () of nerves that supplies the organs of the pelvic cavity. The inferior hypogastric plexus gives rise to the prostatic plexus in males and the uterovaginal plexus in female ...

to the spinal columns. The excision of presacral nerve trunk results in the obstruction of the pain pathway from the hypogastric plexi to the spinal cord. Presacral neurectomy denervates the uterus and causes loss of some bladder sensation.

Efficacy

Presacral neurectomy is offered to patients for whom medical therapy for chronic pain relief has failed. The efficacy of the procedure is around 75-80%. Less than 1% of all patients have major complications following the surgery.

References

{{reflist Abdominal surgical procedures Gynecological surgery Pain management