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Presacral sympathectomy

A presacral sympathectomy has been used to alleviate pelvic pain from dysmenorrhea and pelvic cancer

The presacral space is that between the rectum and the lowest part of the spine. It is normally filled with fat.

A presacral sympathectomy is the cutting or cauterisation of the ganglion of nerves in and by this space.

It is a treatment for pelvic pain – nerves in this area being those that carry that pain to the brain.

There are a number of conditions that might be aided by a presacral sympathectomy.

Historically it has been used to treat dysmenorrhea, this is uncommon today.

The removal of pelvic pain indicates it can be useful in treating endometriosis.

The aim is to cut or cauterise the nerves extending from the spine into the presacral space.

This involves arthroscopy – keyhole surgery – and a general anaesthetic. Incisions will be made into the trunk to allow entry into the pelvic region.

Full recovery, allowing a return to work, and substantial physical activity will take about a week.

Physical movement is possible the next day – the incisions necessary are small but will require some rest and time to heal.

The use of a general anaesthetic will usually require an overnight stay in  hospital and returning to home the day after the operation.

All surgery carries risk of infection, blood loss and bruising around the site.

Specific to a sympathectomy there is also the possibility of damage to nerves surrounding the targets.

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