REDUCTION OF ADHESIONS WITH FIBRIN GLUE AFTER LAPAROSCOPIC EXCISION OF LARGE OVARIAN ENDOMETRIOMAS

Study Objective. To evaluate the effect of fibrin glue on the formatio n of adhesions after laparoscopic excision of endometriomas. Design. P rospective case series. Setting. Department of Obstetrics and Gynecolo gy at a university-affiliated hospital. Patients. Thirty women with ov arian cysts. Interventions. In 10 women (16 cysts) we performed laparo scopic resection of endometriomas leaving the ovarian capsule open. Tw enty patients (25 cysts) underwent laparoscopic removal of endometriom as and fibrin glue approximation of the ovarian capsule, as well as co ating of serosal defects with the glue. At second-look-laparoscopy 4 t o 6 months after the initial surgery, postoperative adhesion formation was assessed according to the revised American Fertility Society clas sification. Measurements and Main Results. The mean (+/- SEM) adnexal adhesion score in patients without fibrin glue was 8.6 +/- 2.2 at init ial surgery and increased slightly to 12.6 +/- 2.6 at second-look lapa roscopy. In patients treated with fibrin glue, the score decreased sig nificantly from 10.9 +/- 1.4 to 7.8 +/- 1.3 (p < 0.02). The decrease w as most marked in women with endometriomas 5 cm or more in diameter an d for those with a preoperative adhesion score of 8 or higher. Conclus ion. Fibrin glue reduced postoperative adhesions after laparoscopic re section of endometriomas.