Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis

J Minim Invasive Gynecol. Jul-Aug 2017;24(5):822-826. doi: 10.1016/j.jmig.2017.02.027. Epub 2017 Apr 23.

Abstract

Objective: To report neurologic follow-up of patients after laparoscopic large resection of deep infiltrating endometriosis of the sciatic nerve.

Design: Prospective clinical case series.

Setting: Tertiary referral unit specializing in advanced gynecologic surgery and neuropelveology.

Patients: All data for patients who underwent laparoscopic surgery for endometriosis of the sciatic nerve between 2004 and 2016 (n = 259) were documented prospectively. In this study, patients who underwent a large resection of the sciatic nerve (>30% of the nerve) and were followed for at least 5 years were evaluated (n = 46). All patients presented preoperatively with incapacity for normal gait and foot drop. All were suffering from intractable and constant neuropathic sciatic pain (visual analog scale [VAS] score of 9 to 10 despite strong pain medicine), with sensorimotor disorders of the affected leg.

Interventions: Laparoscopic large resection of endometriosis of the sciatic nerve.

Measurements and main results: All procedures were performed by laparoscopy. Postoperative management included medical treatment with neuroleptic agents and intensive physiotherapy. At the 5-year follow-up, all patients reported significant pain reduction, with a median VAS score of 2.1 (range, 0 to 3) and recovery of normal gait, including the ability to climb stairs.

Conclusion: In deep infiltrating intraneural endometriosis of the sciatic nerve, patients present with motor disorders before and after surgical resection. The average VAS score was reduced from 9.33 preoperatively to 1.25 at a 3-year follow-up. When full resection of endometriosis including nerve resection is completed, sciatic nerve function recover, but recovery of a normal gait may take at least 3 years and intensive physiotherapy.

Keywords: Laparoscopy; Neuropelveology.

MeSH terms

  • Adult
  • Endometriosis / pathology
  • Endometriosis / surgery*
  • Female
  • Follow-Up Studies
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / rehabilitation
  • Gait Disorders, Neurologic / surgery
  • Gynecologic Surgical Procedures / adverse effects
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Laparoscopy* / adverse effects
  • Laparoscopy* / methods
  • Pain / etiology
  • Pain / rehabilitation
  • Peritoneal Diseases / etiology
  • Peritoneal Diseases / rehabilitation
  • Peritoneal Diseases / surgery
  • Recovery of Function
  • Sciatic Nerve / pathology
  • Sciatic Nerve / physiopathology
  • Sciatic Nerve / surgery*
  • Sciatic Neuropathy / pathology
  • Sciatic Neuropathy / rehabilitation
  • Sciatic Neuropathy / surgery*
  • Time Factors
  • Treatment Outcome
  • Young Adult