Bilateral laparoscopic transperitoneal ligation of ovarian veins for treatment of pelvic congestion syndrome

STUDY OBJECTIVE: To evaluate the efficacy and safety of bilateral laparoscopic transperitoneal ligation of the ovarian veins in women with symptomatic pelvic varices. DESIGN: Prospective pilot study performed in a small series (Canadian Task Force classification III). SETTING: Urban hospital in Turin and University hospital in Cagliari, Italy. PATIENTS: Twenty-three women. INTERVENTION: Bilateral laparoscopic transperitoneal ligation of the ovarian veins. The right ovarian vein was reached by incising posterior peritoneum below the mesentericoparietal fossa in all women. The left ovarian vein was reached by reflecting medially the left colon in 10 women and by incising the posterior peritoneum covering the aorta 2 cm below the inferior duodenal fold in 13. MEASUREMENTS AND MAIN RESULTS: After the plateau of the learning curve was reached, average operating time was about 60 minutes without complications. Complete remission of pain and absence of pelvic varicosities lasted for 12 months. CONCLUSION: The laparoscopic transperitoneal paraaortic approach to bilateral ligation of ovarian veins near their origin could be a new treatment option for pelvic congestion syndrome.