SANDRIESER Lejla

Perioperative Dynamics of Pelvic Myofascial Pain in Patients Undergoing Laparoscopy due to Endometriosis

Endometriosis is a chronic disease, characterized by endometrial tissue outside the uterine cavity, leading to severe symptoms like chronic pelvic pain, dysmenorrhea, dyschezia, dysuria, dyspareunia and infertility. Approximately 10-15% of women in reproductive ages suffer from endometriosis. Ectopic endometrial lesions can be found on the peritoneum, the ovaries, the rectovaginal septum, the bladder, the intestine or – rarely – in the lungs and brain.

The pathophysiology is not fully understood. However, ectopic endometrial lesions are suspected to cause an inflammation, which in the further course leads to central sensitization, hyperalgesia and allodynia. Persistent pelvic irritation then leads to a constant contraction of pelvic muscles and the formation of myofascial trigger points (MTrPs) – small palpable nodules, that can be painful spontaneously or upon perturbation. Once MTrPs are formed, they can be a self-sustaining source of pain, even after surgical excision of endometrial lesions.

The chronic presence of pain does not only affect a woman’s physical state but also causes am impaired quality of life. Existing studies examining the effectiveness of laparoscopic surgery in reducing pelvic pain used a standardized questionnaire with a visual analogue scale (VAS) to evaluate and compare pain levels.

However, to the best of our knowledge, the effect of surgical treatment of endometriosis on the postoperative dynamics of pelvic myofascial pain is unknown.

In 2019, a standardized, reproducible examination for assessment of pelvic myofascial pain was developed. Performing this examination before and after laparoscopic surgery enables us to objectively evaluate myofascial pain reduction after surgical removal of endometriosis.

Methods and Skills:

Clinical studies; gynecological ultrasound

Publications:

Sandrieser L, Husslein H, Perricos A, Wenzl R, Feichtinger M, Kuessel L. Vaginal transisthmic myomectomy: a step by step video tutorial. Fertil Steril 118: 990-991, 2022

Sandrieser L, Kuessel L, Perricos A, Wenzl R, Husslein H. Myomectomy for a large uterine fibroid via mini-laparotomy: a step-by-step video tutorial. Fertil Steril 117: 456-457, 2022

Pfisterer N, Dexheimer C, Fuchs EM, Bucsics T, Schwabl P, Mandorfer M, Gessl I, Sandrieser L, Baumann L, Riedl F, Scheiner B, Pachofszky T, Dolak W, Schrutka-Kölbl C, Ferlitsch A, Schöniger-Hekele M, Peck-Radosavljevic M, Trauner M, Madl C, Reiberger T. Betablockers do not increase efficacy of band ligation in primary prophylaxis but they improve survival in secondary prophylaxis of variceal bleeding. Aliment Pharmacol Ther  47: 966-979, 2018