Laparoscopy for adhesion prevention following myomectomy.

OBJECTIVE

To evaluate adhesion formation after classic abdominal myomectomy 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 abortion or symptomatic myoma underwent second-look laparoscopy (SLL) 8 days after abdominal myomectomy. The degree of adnexal adhesions were scored according to the American Fertility Society Classification and were lyzed laparoscopically. The success of the SLL was evaluated in 18 patients who underwent a third-look procedure (cesarean section or laparoscopy)

RESULTS

Myomectomy incisions on the posterior uterine wall were 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 smaller 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 not found to affect adhesion formation (P > 0.05). In the patients who underwent a third-look procedure, adhesion scores were found to be significantly lower than the SLL (6.2 +/- 6.4 vs. 3.1 +/- 3.4) (P < 0.01).

CONCLUSION

Myomectomy operations frequently result in pelvic adhesions, which may impair fertility. Early laparoscopy and adhesiolysis after myomectomy is useful for assessing the degree of adhesions, technical ease in performing adhesiolysis and resulting in lower adhesion scores as shown by third-look procedures.