Everything you ever wanted to know about ”The post-Pfannestiel pain syndrome”

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T. Verhagen, M. Loos, M. Scheltinga, R. Roumen

Moderator(s): Henk Ten Cate Hoedemaker (Groningen, The Netherlands) & Harry van Goor (Nijmegen, The Netherlands)

13:20 - 13:30h at Jurriaanse Zaal

Categories: Session 7. Innovative techniques and future perspectives

Parallel session: Session 7. Innovative techniques and future perspectives

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The post-Pfannenstiel pain syndrome in women: consider abdominal wall endometriosis

Background:
Chronic pain after Pfannenstiel incisions may be caused by nerve entrapment. However, pain is occasionally due to abdominal wall endometriosis (AWE). Aim of the study was to describe the clinical picture of AWE and discuss results of surgery.

Methods:
Women with a Pfannenstiel incision performed between January 2000 and August 2010 with a histological diagnosis of AWE underwent an interview and physical examination. Pain was measured at various time points using VAS (0-100) and VRS (1-5).

Results:
All Pfannenstiel incisions (n=21) were performed for cesarean deliveries. Pain had started at a median of 38 months after the initial procedure. It was moderate to severe (mean VAS = 44 [95%CI: 32-55]) and appeared related to the menstrual cycle in three-quarters of the women. Nine reported cyclic swelling. More than half of the population (n=11) suffered from functional impairment due to the pain. Surgical removal was performed some 15 months after onset of pain. All women were pain free 3 months after AWE removal (mean VAS = 5 [95%CI: 1-9], p<0.001). However, at follow up median 26 months after surgery, six initially pain free women experienced renewed pain which was based on recurrent AWE in four.

Conclusions:
Pain in a Pfannenstiel incision several years after a cesarean delivery may be caused by abdominal wall endometriosis. AWE pain is often cyclic and a mass may be palpated. The pain is substantial and can cause severe functional impairment. Surgical removal is successful on the long term but recurrent disease is not uncommon.