title: Should women with chronic pelvic pain have adhesiolysis?
abstract: BACKGROUND
  Pelvic adhesions are found in up to 50% of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions, and the clinical benefit of adhesiolysis in the context of CPP is still unclear. Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP) and adhesions.
  
  
  METHODS
  This was a double-blinded RCT. This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4 years. Women with chronic pelvic pain (CPP) were randomized into having laparoscopic adhesiolysis or diagnostic laparoscopy. Women were assessed at 0, 3 and 6 months for Visual analogue scale scores (VAS) and Quality of Life (QoL) measures (SF-12 and EHP-30).
  
  
  RESULTS
  A total of 92 participants were recruited; 50 qualified to be randomized, with 26 in the adhesiolysis and 24 in the control group. The results are expressed in median (interquartile ranges). In women who underwent adhesiolysis, there was a significant improvement at 6 months in VAS scores (-17.5 (-36.0 - -5.0) compared to controls (-1.5 (-15.0 - 4.5; p = 0.048); SF-12 scores physical component score (25.0 (18.8 - 43.8)) compared to controls (6.3 (-6.3 - 18.8); p = 0.021), SF-12 emotional component score 32.5 (4.4 - 48.8) compared to controls -5 (-21.3 - 15.0); p < 0.0074) and EHP-30 emotional well being domain 32.5 (4.4 - 48.8) compared to the controls -5 (-21.3 - 15.0; p < 0.0074).
  
  
  CONCLUSIONS
  This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding. In selected population of women presenting to the gynecological clinic with chronic pelvic pain, adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life.
  
  
  BACKGROUND
  ISRCTN 43852269.
authors.affiliation: Human Development and Health, Faculty of Medicine, University of Southampton, Coxford Road, Southampton SO16 5YA, UK. y.cheong@soton.ac.uk.
authors.forename: Ying C
authors.initials: YC
authors.lastname: Cheong
authors.forename: Isobel
authors.initials: I
authors.lastname: Reading
authors.forename: Sarah
authors.initials: S
authors.lastname: Bailey
authors.forename: Khaled
authors.initials: K
authors.lastname: Sadek
authors.forename: William
authors.initials: W
authors.lastname: Ledger
authors.forename: Tin C
authors.initials: TC
authors.lastname: Li
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000150:complications / Q000523:psychology / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery