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Gynaecology · UK

Presacral neurectomy - targeting central period pain.

A precise, keyhole operation that divides the superior hypogastric plexus to relieve severe, midline period pain - often performed alongside excision of endometriosis, by a surgeon who does it deliberately.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private presacral neurectomy costs in the UK.

Indicative ranges across our partner gynaecology units.

In short

£6,000–£9,500, home day-case or one night.

Procedure Indicative range
Laparoscopic presacral neurectomy (alone) £6,000–£9,500
Presacral neurectomy with endometriosis excision £9,000–£16,000
Diagnostic laparoscopy first £3,500–£6,000
Pelvic MRI (endometriosis protocol) £450–£900
Robotic-assisted presacral neurectomy £10,000–£18,000
Gynaecology consultation only £250–£450

Prices vary by hospital, by the consultant, by approach (laparoscopic, robotic), and above all by whether extensive endometriosis excision is done at the same sitting. Combined and robotic cases sit at the top of the range.

The problem

The right pain, the right patient, the right surgeon.

Presacral neurectomy is where selection is everything. Offered to the wrong pain pattern it disappoints; offered to genuine central dysmenorrhoea by an experienced surgeon it can be transformative. We get all three right.

  • Is the pain truly central?

    This operation helps midline period pain - not one-sided or bowel pain.

  • Treat the disease too

    If endometriosis is present, it still needs excising. The neurectomy targets the pain pathway, not the condition.

  • A surgeon at home in the presacral space

    The plexus sits between the great vessels. Experience with this specific anatomy is what keeps the operation safe.

When it helps

When presacral neurectomy is the right step.

The situations where it genuinely helps, plus the one red flag that means proper assessment first rather than a nerve operation.

  • Central, midline dysmenorrhoea

    Severe period pain felt in the middle of the lower abdomen - the specific pattern presacral neurectomy is designed to relieve.

  • Endometriosis-related pain

    Often performed alongside laparoscopic excision of endometriosis, targeting the midline component of the pain.

  • Pain that resists medical treatment

    When hormonal therapy and analgesia have been tried properly and central period pain persists.

  • Primary dysmenorrhoea, severe and disabling

    Occasionally considered for very severe primary period pain with no other pelvic pathology, after conservative options fail.

  • Recurrent midline pain after prior surgery

    Where earlier pelvic surgery has not settled the central component of the pain.

  • Wanting to preserve fertility

    Presacral neurectomy does not remove reproductive organs, so it can be an option for women who wish to keep the possibility of pregnancy.

  • Considered before hysterectomy

    For selected women, targeting the nerves may be preferable to removing the uterus.

  • Red flag: lateral pain, or pain with bleeding and weight loss

    One-sided pelvic pain, or pain with abnormal bleeding, bowel change or weight loss, needs proper gynae-oncology assessment first - not a nerve operation.

Procedure options

Approach and scope depend on your pelvis.

What each option involves - approach (laparoscopic, robotic, open) and whether it is combined with excision of endometriosis.

  • Laparoscopic presacral neurectomy

    The standard approach - keyhole division of the superior hypogastric plexus over the sacral promontory, in the presacral space bounded by the great vessels.

  • Robotic-assisted neurectomy

    The da Vinci platform can help in the confined presacral space, offering fine control near the iliac vessels and ureters.

  • Combined with endometriosis excision

    Most often performed at the same sitting as laparoscopic excision of endometriosis, so both the disease and the midline pain pathway are addressed together.

  • Presacral neurectomy vs uterosacral ablation

    A different, largely abandoned operation (LUNA) targets the uterosacral nerves; presacral neurectomy targets the hypogastric plexus and has better evidence for central pain.

  • Open presacral neurectomy

    Rarely used today - reserved for cases where dense adhesions or prior surgery make a laparoscopic approach unsafe.

  • Diagnostic laparoscopy first

    Where the diagnosis is uncertain, a diagnostic laparoscopy maps the pelvis before committing to nerve division.

  • Nerve-sparing alternatives

    For pain that is not truly central, targeted excision, hormonal treatment or pain-management pathways may serve better.

  • Selective vs complete division

    The surgeon divides the plexus completely within defined anatomical landmarks to give the operation its best chance of working.

Safety and recovery

What to expect afterwards - honestly.

Presacral neurectomy is an established but specialised operation. The things worth planning are the anatomical risk, the bowel and bladder effects, and honest expectations about what it can relieve.

  • GA in a proper theatre

    Presacral neurectomy is done under general anaesthetic. Most cases are day-case or one night, longer if combined with extensive endometriosis excision.

  • Bleeding near the great vessels

    The presacral space lies between the iliac vessels and over the sacral veins. Bleeding is the main intraoperative risk, which is why surgeon experience matters so much.

  • Constipation is common afterwards

    Dividing the sympathetic nerves can slow the bowel. Constipation is the most frequent lasting side effect and is managed with diet, fluids and laxatives.

  • Bladder and urinary changes

    Some women notice reduced bladder sensation or urinary urgency. This is usually mild but should be discussed before surgery.

  • It only helps central pain

    The operation relieves midline period pain. Lateral pain, deep pain with intercourse and bowel symptoms are not reliably improved - realistic expectations are essential.

  • Painless labour is possible afterwards

    Because the nerves carrying uterine pain are divided, some women who later give birth report reduced or absent labour pain - worth knowing in advance.

  • Not a substitute for treating disease

    If endometriosis is present, it still needs treating. Presacral neurectomy addresses the pain pathway, not the underlying condition.

  • Infection, clots and hernia

    As with any laparoscopy: low rates of wound or pelvic infection, DVT (prophylaxis is standard) and port-site hernia.

  • Red flags after surgery

    Fever, severe abdominal pain, heavy bleeding, breathlessness or calf pain need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach was used - laparoscopic or robotic - and whether or not endometriosis was excised, the note the surgeon sends you keeps to the same shape.

A UK consultant gynaecologist reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the expected outcome before your review, just ask.

  1. 01 Header

    Indication and pain pattern

    Why the operation was done and which pain pattern it targeted - the central, midline component of your period pain.

  2. 02 Technique

    Approach and anatomy

    Whether it was laparoscopic, robotic or open, and how the superior hypogastric plexus was identified and divided within the presacral landmarks.

  3. 03 Findings

    Other pelvic findings

    Any endometriosis, adhesions or other pathology seen and treated at the same time.

  4. 04 Impression

    Expected outcome and aftercare

    Read this first: what improvement to expect, the bowel and bladder changes to watch for, and the follow-up plan.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Presacral neurectomy is usually covered when medically indicated for severe dysmenorrhoea, particularly alongside endometriosis surgery.

Frequently asked

Everything we get asked about presacral neurectomy.

Quick answers on which pain it helps, endometriosis, side effects, cost and NHS access.

  • What is a presacral sympathectomy?

    A presacral sympathectomy, more precisely called presacral neurectomy, is an operation that divides the superior hypogastric plexus - a bundle of sympathetic nerves lying in front of the sacrum. These nerves carry central, midline pain signals from the uterus, so cutting them can relieve severe period pain that is felt in the middle of the lower abdomen.

  • What kind of pain does it help?

    It helps central, midline dysmenorrhoea - period pain felt in the middle of the lower abdomen. It does not reliably relieve one-sided (lateral) pain, deep pain during intercourse, or bowel-related pain. Choosing the right patient with the right pain pattern is the single biggest factor in whether the operation works.

  • Is it done for endometriosis?

    Frequently, yes. Presacral neurectomy is often performed at the same time as laparoscopic excision of endometriosis, targeting the midline pain component while the excision treats the disease itself. It is important to understand that the neurectomy addresses the pain pathway, not the underlying endometriosis, which still needs treating.

  • What are the main side effects?

    The most common lasting side effect is constipation, because the divided nerves also influence the bowel. Some women notice reduced bladder sensation or urinary urgency. These are usually manageable, but they should be discussed and planned for before surgery. Bleeding near the large pelvic blood vessels is the main risk during the operation itself.

  • How much does it cost privately in the UK?

    Roughly £6,000–£9,500 for laparoscopic presacral neurectomy alone, £9,000–£16,000 when combined with endometriosis excision, and £10,000–£18,000 for a robotic-assisted approach. A pelvic MRI or diagnostic laparoscopy beforehand is quoted separately.

  • Is it available on the NHS?

    Presacral neurectomy is performed within the NHS but only in specialist endometriosis and pelvic-pain centres, and only for carefully selected patients after other treatments have been tried. Because it is a niche operation, access can be limited and waiting times long, which is why some women choose to arrange assessment and surgery privately.

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