Study Explores Laparoscopic Ligation of Varicosities


SAN DIEGO — Laparoscopic ligation of broad ligament varicosities in the management of chronic gynecologic pelvic pain is a “safe and relatively simple” procedure, Mark Erian, M.D., reported at an international congress of the Society of Laparoendoscopic Surgeons.

“Unlike laparoscopic ligation of ovarian varicosities, laparoscopic ligation of broad ligament varicosities is uncommonly reported in the medical literature,” said Dr. Erian, an ob.gyn. based in Brisbane, Australia.

From March 2000 to November 2004, 15 women with a mean age of 27 and a mean parity of two underwent video laparoscopy at the Royal Brisbane and Women's Hospital to treat unilateral or bilateral broad ligament varicosities. Dr. Erian and his associate, Glenda McLaren, M.D., employed a four-portal entry technique to allow for maximal access and maneuverability of instruments.

The women also underwent diagnostic hysterectomy and endometrial sampling to exclude unsuspected endometrial pathology.

Follow-up was conducted at 1 week, 6 weeks, 3 months, 6 months, and then at yearly intervals. “Adequate communication channels between the family physician and the gynecologic surgeon were maintained at all times,” Dr. Erian said.

At baseline, all study participants reported symptoms of pelvic pain, which they described as heaviness that is present most of the time. The mean operative time was 19 minutes, and the mean estimated blood loss was 10 mL per patient.

Follow-up at 6 weeks and 4 years showed complete or partial resolution of pain to what Dr. Erian described as “a mild and well-tolerated level” in 13 of the 15 women. “In one case, the patient reported considerable midcycle ovulation pain that completely resolved by suppression of ovulation with combined oral contraceptive pills,” he said. “In the last patient in this series, the pain was reported to have not changed. She was referred to a gastroenterologist and was diagnosed with irritable bowel syndrome, and the case was treated accordingly.”

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