EDITORIAL COMMENT: This article once again emphasizes that hysterectomy can be successful in alleviating chronic pelvic pain even in those women in whom the operative pathology is not usually associated with pain. Hillis (A) showed that in a group of 308 women who had a hysterectomy for chronic pelvic pain and were followed up for at least 6 months, 74% experienced complete resolution of pelvic pain and a further 21% reported decreased pain. Hillis found that pain was more likely to resolve in women with identifiable pathology, private health insurance or fewer than 2 pregnancies. However even in women with no identifiable pelvic pathology, 62% had complete resolution of their pain postoperatively. This indicates that in the woman for whom all other therapy has failed, after appropriate counselling, hysterectomy may be a reasonable option for the treatment of chronic pelvic pain.
(A) Hillis SD, Marchbanks PA, Peterson HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol 1995; 86: 941–945.
Summary: The outcome of abdominal hysterectomy for pelvic pain in premenopausal women was studied retrospectively in 228 women. In 17 women, pelvic pain was the sole indication while in the others, pelvic pain was one of the contributory indications for hysterectomy. The most common surgical histopathological diagnoses were uterine leiomyoma (73.9%), uterine adenomyosis (40.4%), benign ovarian cyst (19.3%) and endometriosis (7.9%); 118 (51.8%) patients had single pathology and 48.2% had multiple pathologies. The agreement between operative clinical diagnosis and histopathological diagnosis was 66.1% for leiomyoma, 57.1% for uterine adenomyosis and 30% for endometriosis. The incidence of early postoperative complication was 20.6%, mainly minor morbidities including urinary tract infection (3.9%), wound infection (3.1%) and unexplained fever (6.0%). These complications significantly prolonged the duration of hospital stay from an average of 7 days to 9–17 days. Of 98 patients with pain as the sole or the most predominant indication for hysterectomy, 72% responded to an outcome survey 12 or more months after hysterectomy. Of these, 62 (87%) were satisfied with the operation, 8 were unsure and 1 was dissatisfied; 68 (95.8%) patients reported relief of their symptoms. Relief of symptoms did not correlate with the patient’s report of her satisfaction with hysterectomy. Pain in the abdominal wound a year or more after surgery was one of the commonest reasons cited for dissatisfaction with hysterectomy. We conclude that in well‐selected cases, hysterectomy is an appropriate and satisfactory treatment for premenopausal women with pelvic pain irrespective of clinical evidence of associated pathology. Effective measures to reduce postoperative complications and wound pain are needed to further improve the outcome of abdominal hysterectomy.