LAPAROSCOPY FOR ADHESION PREVENTION FOLLOWING MYOMECTOMY

Objective: To evaluate adhesion formation after classic abdominal myom ectomy and the role of early, second-look laparoscopic adhesiolysis in the management of post-myomectomic pelvic adhesions in a prospective study. Method: Forty-eight patients with infertility, recurrent aborti on or symptomatic myoma underwent second-look laparoscopy (SLL) 8 days after abdominal myomectomy. The degree of adnexal adhesions were scor ed according to the American Fertility Society Classification and were lyzed laparoscopically. The success of the SLL was evaluated in 18 pa tients who underwent a third-look procedure (cesarean section or lapar oscopy) Results: Myomectomy incisions on the posterior uterine wall we re associated with more adhesions than that on the fundus or anterior wall (P < 0.01). Myomectomies performed on uteri larger than 13 weeks gestation resulted in significantly higher adhesion scores than smalle r ones (P < 0.001) and mainly intra-mural myomas than only sub-serous ones (P < 0.01). More than one uterine incision was found to result in more adhesions (P < 0.05), while the number of myomas removed were no t found to affect adhesion formation (P > 0.05). In the patients who u nderwent a third-look procedure, adhesion scores were found to be sign ificantly lower than the SLL (6.2 +/- 6.4 vs. 3.1 +/- 3.4)(P < 0.01). Conclusion: Myomectomy operations frequently result in pelvic adhesion s, which may impair fertility. Early laparoscopy and adhesiolysis afte r myomectomy is useful for assessing the degree of adhesions, technica l ease in performing adhesiolysis and resulting in lower adhesion scor es as shown by third-look procedures.