Comparison of the prevalence of adhesions at the time of diagnostic laparoscopy for infertility between patient who had open myomectomy and those who had no previous pelvic-abdominal surgery or pelvic inflammatory disease

OBJECTIVE: The aim of this study is to determine the prevalence and patterns of adhesions in infertile women with prior open myomectomy compared with women without prior pelvic-abdominal surgery. METHODS: A nested case-control study of infertile women who had diagnostic laparoscopy after open myomectomy between January 2008 and June 2015 in Life Institute for Endoscopy Limited, Nnewi Nigeria, was conducted. At diagnostic laparoscopy, the presence, site, and quality (density) of adhesions was noted and recorded. Women with endometriosis and documented prior pelvic infections were excluded. RESULTS: Of the 348 women who were eligible, 121 women had prior open myomectomy (study group) while 227 had none (control group). Of the 121 women, adhesions were detected in 97 women; thus, the prevalence of adhesion after open myomectomy was 80.2% versus 20.3% (46/227) in controls (odds ratio [OR] =15.90; 95% confidence interval [CI] =8.86-28.76; P < 0.001). Compared with controls, adhesions were statistically higher in these sites: uterus (68.6% vs. 14.5%), fallopian tubes (77.7% vs. 16.7%), ovaries (62.8% vs. 20.3%), cul-de-sac (66.1% vs. 16.3%), bladder (45.5% vs. 7.9%), and bowel (53.7% vs. 6.2%) (P < 0.001, for all). Cohesive form of adhesions was also statistically higher, 54 (44.6%) vs. 32 (14.1%) (P < 0.05). CONCLUSION: In infertile women, post-open myomectomy adhesions have a high prevalence of 80.2% with high predilection in fallopian tubes and uterus, compared with women without prior abdominopelvic surgery at 20.3%. Cohesive form of adhesion predominates.