Presacral neurectomy

Surgical procedure for chronic pelvic pain

Presacral neurectomy

Diagram of the autonomic nervous system, showing the location of the presacral nerves.

A presacral neurectomy is a surgical procedure that involves the removal of the presacral nerves. This procedure is primarily used to treat chronic pelvic pain, particularly in cases of severe dysmenorrhea that do not respond to other treatments. The presacral nerves are part of the autonomic nervous system and are located in the pelvic cavity, anterior to the sacrum.

Indications

Presacral neurectomy is indicated for patients suffering from chronic pelvic pain, especially when associated with conditions such as endometriosis or severe dysmenorrhea. It is considered when other medical and surgical treatments have failed to provide relief. The procedure aims to interrupt the transmission of pain signals from the pelvic organs to the central nervous system.

Procedure

The procedure is typically performed under general anesthesia. The surgeon makes an incision in the abdomen to access the pelvic cavity. The presacral nerves are located in the retroperitoneal space, and careful dissection is required to avoid damage to surrounding structures such as the ureters and major blood vessels. Once identified, the presacral nerves are excised.

Risks and complications

As with any surgical procedure, presacral neurectomy carries risks, including bleeding, infection, and injury to surrounding organs. Specific complications related to this procedure include constipation, urinary retention, and potential damage to the hypogastric plexus, which can affect bladder and bowel function.

Recovery

Recovery from presacral neurectomy involves managing postoperative pain and monitoring for any complications. Patients may experience changes in bowel and bladder habits, which should be discussed with the healthcare provider. Follow-up appointments are necessary to assess the effectiveness of the procedure in alleviating pelvic pain.

Related pages

• Endometriosis
• Dysmenorrhea
• Pelvic pain
• Autonomic nervous system