Effect of the First Laparoscopy in an Adolescent and Young Adult Female Population and Its Association With Chronic Pelvic Pain: A Randomised Controlled Trial.

Background: Chronic pelvic pain (CPP) is a common and debilitating presentation for adolescent and young adult females. Medical management is often utilised as first line therapy with surgical management considered if medical treatment has been unsuccessful. Laparoscopy in this young population remains controversial due to the high recurrence rate of pain, requirement for repeat surgeries and surgical risks. There is a need for prospective, longitudinal studies comparing medical and surgical management to guide management of young patients with CPP.

Aims: To determine the effect of the first laparoscopy in an adolescent and young adult female population and assess its association with CPP.

Materials and methods: Patients aged 16-25 will be recruited from the gynaecological service at the study sites. Consented participants will be randomised to the surgical or non-surgical arms. Those in the surgical arm will have a laparoscopy performed and those in the non-surgical arm will be medically managed. At recruitment and at 6 weeks, 6 months, 12 months and 24 months follow-up, patients will complete a number of validated questionnaires assessing pain and quality of life. An amendment was made to methodology to include patients who will choose their management pathway for CPP.

Results: An independent t-test or Mann-Whitney U test will be used to compare the questionnaire scores between the surgical and non-surgical groups. For questionnaire scores at baseline and follow-up within the same arm, a paired t-test or Wilcoxon signed-rank test will be used. A p-value of < 0.05 will be statistically significant.