TRANSVAGINAL ULTRASONOGRAPHIC ASSESSMENT OF HYSKON OR LACTATED RINGERS SOLUTION INSTILLATION AFTER LAPAROSCOPY - RANDOMIZED, CONTROLLED-STUDY

We sought to evaluate two common fluids placed in the pelvis after pel vic surgery for their ability to remain in the pelvis for a time thoug ht adequate for prevention of adhesions. Thirteen patients undergoing operative laparoscopy were randomized to receive 250 ml 32% dextran 70 (Hyskon), 250 mi lactated Ringer's solution, or no fluid (control) at the end of surgery. Serial transvaginal ultrasonograms were obtained at I hr,3 hr, 6 hr,24 hr, 96 hr (4 days), and 168 hr (7 days) after su rgery. Patients were asked about side effects of fluid instillation. T he volume of lactated Ringer's solution declined rapidly after instill ation, with no significant difference from control at 24 hr (12 mi ver sus 7 mi). The volume of Hyskon did not decline rapidly by 24 hr and r emained higher than the volume in controls or those receiving lactated Ringer's solution (188 mi, P = 0.003). Although the volume of Hyskon remained higher than that of lactated Ringer's solution or fluid volum e in control patients by days 4 and 7, this difference did not reach s tatistical significance (45 mi versus 7 mi and 14 mi respectively, P = 0.39, on day 4). Patients in all groups noted abdominal pain. One pat ient who received Hyskon developed severe vulvar edema and another dev eloped dyspnea. We conclude that the volume of Hyskon in the peritonea l cavity after laparoscopy does not decline as rapidly as does that of lactated Ringer's solution; however, significant side effects may lim it its usefulness. Transvaginal ultrasonography is useful in monitorin g fluids placed in the pelvis for prevention of adhesions.