ObjectiveTo evaluate the efficacy and complications of laparoscopic presacral neurectomy in pelvic pain.MethodsWe reviewed records of 655 patients receiving laparoscopic surgery and laparoscopic presacral neurectomy for diagnoses including adenomysis with dysmenorrhea (n= 55), moderate and severe endometriosis with dysmenorrhea (n= 127), minimal and mild endometriosis with dysmenorrhea (n= 208), primary dysmenorrhea (n= 99), and chronic pelvic pain with or without pathologic disease (n= 166). Pain relier was evaluated at least 12 months postoperatively.ResultsPain relief was evaluated in 157 patients. Significant pain relief (no pain or mild pain requiring no medication) was found in 22 (52%) of 42 women with adenomysis, in 75 (73%) or 103 with moderate to severe endometriosis with dysmenorrhea, in 123 (75%) of 164 with minimal to mild endometriosis with dysmenorrhea, in 64 (77%) of 83 with primary dysmenorrhea, and in 84 (62%) of 135 with chronic pelvic pain. There were four major complications (0.6%) that required further surgery, including injury of the right internal iliac artery (n= 1) and chylous ascites (n= 3). Three cases (0.5%) had laceration of the middle sacral vein controlled during laparoscopy. In addition, 485 (74%) of the 655 patients complained of constipation after laparoscopic presacral neurectomy, which was relieved easily by medication.ConclusionPresacral neurectomy can be performed safely and efficiently by laparoscopy and is a valuable alternative treatment for pelvic pain.