Background: Piriformis syndrome is an uncommon disease result from compression of the sciatic nerve by the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. This study analyzes the laparoscopic surgical treatments of pelvic piriformis syndrome. Presentation: We report two cases of pelvic piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back and sciatalgia on her right side. The severity of the pain was 10/10 on the visual analog scale(VAS). Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The laparoscopic decompression surgery was performed to release the right sciatic nerve from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 0/10. The second case was a 30 years old woman with a 2-year history of sciatalgia on her left side. Her VAS was 9/10. The laparoscopic decompression surgery was performed to release the left sciatic nerve and left sacral nerve S2 dermatome from the aberrant piriformis muscle. Postoperative 3 and 6 months follow-up, her VAS decreased to 1/10. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is thought to be an exclusively clinical diagnosis. The sciatica is refractory despite appropriate conservative treatments; laparoscopic exploration of the pelvic nerves and piriformis muscle and decompression surgery can be a good option. Keywords: Laparoscopy, pain, piriformis muscle syndrome, sacral nerve root, the sciatic nerve.