OBJECTIVE: Endometriosis is associated with neuropathic pain in approximately 40% of cases. Involvement of the sciatic nerve or sacral plexus represents one of the most frequently reported neuropathic pain presentations in endometriosis, for which no specific management guidelines currently exist. This study evaluate the efficacy and safety of laparoscopic decompression of the sciatic nerve or the sacral plexus for neuropathic sciatic pain caused by endometriosis. METHOD: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines using PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov for studies published between 2000 and 2025. Eligible studies included interventional and observational studies reporting outcomes in women undergoing laparoscopic decompression for neuropathic pain located along the sciatic nerve distribution due to endometriosis involving the sciatic nerve and/or the sacral plexus. Data extraction was performed independently by two reviewers. W le, a random-effects meta-analysis was conducted. The primary outcome was the variation of sciatic pain intensity from baseline to postoperative follow-up, assessed at least 3 months after surgery using validated pain scales. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal checklists. RESULTS: The search identified 933 records, of which eight studies were included in the final analysis, comprising 744 individuals. Preoperative sciatica attributable to endometriosis was reported in 83.2% of cases (n = 619). Operative findings revealed sciatic nerve involvement in 52.3% of cases (n = 389) and sacral nerve root involvement in 45.0% (n = 335). In a minority of individuals, involvement of other pelvic nerves was also reported. Across five studies with extractable pain-intensity data (n = 520), the pooled mean reduction in sciatic pain was 6.47 points (95% confidence interval 5.55-7.43) on validated 10-point scales. Complete resolution of neuropathic symptoms in the lower limb was reported in a subset of individuals. Major complications occurred in 8% of cases and were mainly associated with concomitant pelvic procedures. CONCLUSION: Laparoscopic nerve decompression appears to be associated with a clinically significant reduction in neuropathic sciatic pain related to endometriosis, with a low incidence of major nerve-related complications. However, as the available evidence is predominantly observational and characterized by a low to moderate risk of bias, these findings should be interpreted with caution and highlight the need for further well-designed studies. PROSPERO REGISTRATION: The study protocol was prospectively registered in PROSPERO (CRD420251107880) on July 19, 2025.
Racca et al. (Wed,) studied this question.