The significance of early second-look laparoscopy after myomectomy by laparotomy

Tatsuya Harada, Tomonori Ishikawa, Tomomi Okawa, Naoyuki Yoshiki, Toshiro Kubota
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2010 · vol. 26(2) , pp. 530–534 · doi:10.5180/jsgoe.26.530 · W2319870809
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Early second-look laparoscopy after myomectomy by laparotomy found adhesions in 39 of 57 patients, suggesting a need for improved adhesion prevention strategies, especially in those with endometriosis.

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This study evaluated the efficacy of early second-look laparoscopy in preventing post-operative adhesions following myomectomy by laparotomy in 57 women desiring future conception. The procedure successfully lysed adhesions in approximately 60% of cases, with significant adnexal adhesions found in over 40% of patients regardless of simultaneous adnexal surgery. Notably, the incidence and severity of these adhesions were significantly higher in patients who also had endometriosis compared to those without the condition. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Objective: The purpose of this study is to investigate the significance of early second-look laparoscopy (ESLL) and to evaluate post-operative adhesion formation after myomectomy by laparotomy.Patients: 57 women who wanted to conceive in the future underwent early second-look laparoscopy (ESLL) after myomectomy by laparotomy.Interventions: ESLL was performed to evaluate and to lyse post-operative adhesions at 7 to 14 days after myomectomy by laparotomy.Results: Post-operative adhesions were found in 39 patients and could be removed in 34 of them. Therefore, the efficacy rate of ESLL is about 0.6. Adhesions were found on sutured uterine muscles in 24 patients (42.1%), and new adnexal adhesions were identified in 23 patients (40.4%). The frequency of post-operative adnexal adhesions was similar between patients with and without simultaneous adenexal operations (41.2% vs. 40.0%), and the seriousness of those adhesions was also similar. The rate of post-operative adhesions in patients with endometriosis was significantly higher than that in patients without endometriosis (85.0% vs. 59.5%, p<0.05).Conclusions: Because the rate and the seriousness of post-operative adenexal adhesions were high after myomectomy by laparotomy, we need to make more provisions against adhesions. Because the frequency of adhesions after laparotomy was higher in patients with endometriosis, great care in preventing adhesions should be taken in all other gynecological operations as well.
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Abstract

Objective: The purpose of this study is to investigate the significance of early second-look laparoscopy (ESLL) and to evaluate post-operative adhesion formation after myomectomy by laparotomy. Patients: 57 women who wanted to conceive in the future underwent early second-look laparoscopy (ESLL) after myomectomy by laparotomy. Interventions: ESLL was performed to evaluate and to lyse post-operative adhesions at 7 to 14 days after myomectomy by laparotomy.

Results

Post-operative adhesions were found in 39 patients and could be removed in 34 of them. Therefore, the efficacy rate of ESLL is about 0.6. Adhesions were found on sutured uterine muscles in 24 patients (42.1%), and new adnexal adhesions were identified in 23 patients (40.4%). The frequency of post-operative adnexal adhesions was similar between patients with and without simultaneous adenexal operations (41.2% vs. 40.0%), and the seriousness of those adhesions was also similar. The rate of post-operative adhesions in patients with endometriosis was significantly higher than that in patients without endometriosis (85.0% vs. 59.5%, p<0.05).

Conclusions

Because the rate and the seriousness of post-operative adenexal adhesions were high after myomectomy by laparotomy, we need to make more provisions against adhesions. Because the frequency of adhesions after laparotomy was higher in patients with endometriosis, great care in preventing adhesions should be taken in all other gynecological operations as well. Patients: 57 women who wanted to conceive in the future underwent early second-look laparoscopy (ESLL) after myomectomy by laparotomy. Interventions: ESLL was performed to evaluate and to lyse post-operative adhesions at 7 to 14 days after myomectomy by laparotomy.

Results

Post-operative adhesions were found in 39 patients and could be removed in 34 of them. Therefore, the efficacy rate of ESLL is about 0.6. Adhesions were found on sutured uterine muscles in 24 patients (42.1%), and new adnexal adhesions were identified in 23 patients (40.4%). The frequency of post-operative adnexal adhesions was similar between patients with and without simultaneous adenexal operations (41.2% vs. 40.0%), and the seriousness of those adhesions was also similar. The rate of post-operative adhesions in patients with endometriosis was significantly higher than that in patients without endometriosis (85.0% vs. 59.5%, p<0.05).

Conclusions

Because the rate and the seriousness of post-operative adenexal adhesions were high after myomectomy by laparotomy, we need to make more provisions against adhesions. Because the frequency of adhesions after laparotomy was higher in patients with endometriosis, great care in preventing adhesions should be taken in all other gynecological operations as well. © 2010 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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endometriosis

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