8979 Laparoscopic Lysis of Adhesions: Adhesiolysis, Enterolysis, and Salpingo-Ovariolysis in a Patient with Infertility

Abstract

Study Objective To show the surgical steps used to perform adhesiolysis, enterolysis, and salpingo-ovariolys in a patient with a complex surgical history and a desire for pregnancy, planning to undergo in vitro fertilization treatment. Design Step-by-step video demonstration of the technique. Setting A university tertiary care hospital. Patients or Participants A 36-year-old gravida 2 para 0 with an extensive surgical history – including a cholecystectomy with subsequent exploratory laparotomy on post operative day 2 secondary to hematoma formation, and infertility. Interventions Studies have shown that salpingectomy for hydrosalpinx prior to undergoing in vitro fertilization treatment can improve pregnancy rates. In patients with a prior history of abdominal surgery or other inflammatory event, adhesion formation can obstruct access to the pelvis and distort pelvic anatomy, adding increased complexity to the intended procedure. A diagnostic laparoscopy with adhesiolysis, enterolysis, and salpingo-ovariolysis is performed prior assessing the integrity of the fallopian tubes and ultimately performing bilateral salpingectomy with the aim to improve in vitro fertilization success rates. Measurements and Main Results We discuss three important issues related to lysis of adhesion. First, preoperative and intraoperative considerations regarding abdominal entry and trocar placement. Second, guidelines for lysing specific types of adhesions are discussed, including technique and use of ultrasonic energy. Finally, management of sequela of adhesion lysis such as bowel injury, fallopian tube damage, and obtaining hemostasis are discussed. At postoperative follow up, the patient had healed well and was referred back to reproductive endocrinology to start in vitro fertilization treatments. Conclusion It can be difficult to know preoperatively the extent of adhesive disease in a patient with prior abdominal surgery. Preoperative review of imaging, history, and prior operative reports can help in planning entry. Visualization and skilled intra-operative surgical technique are necessary to perform safe adhesiolysis, enterolysis, and salpingo-ovariolysis. To show the surgical steps used to perform adhesiolysis, enterolysis, and salpingo-ovariolys in a patient with a complex surgical history and a desire for pregnancy, planning to undergo in vitro fertilization treatment. Step-by-step video demonstration of the technique. A university tertiary care hospital. A 36-year-old gravida 2 para 0 with an extensive surgical history – including a cholecystectomy with subsequent exploratory laparotomy on post operative day 2 secondary to hematoma formation, and infertility. Studies have shown that salpingectomy for hydrosalpinx prior to undergoing in vitro fertilization treatment can improve pregnancy rates. In patients with a prior history of abdominal surgery or other inflammatory event, adhesion formation can obstruct access to the pelvis and distort pelvic anatomy, adding increased complexity to the intended procedure. A diagnostic laparoscopy with adhesiolysis, enterolysis, and salpingo-ovariolysis is performed prior assessing the integrity of the fallopian tubes and ultimately performing bilateral salpingectomy with the aim to improve in vitro fertilization success rates. We discuss three important issues related to lysis of adhesion. First, preoperative and intraoperative considerations regarding abdominal entry and trocar placement. Second, guidelines for lysing specific types of adhesions are discussed, including technique and use of ultrasonic energy. Finally, management of sequela of adhesion lysis such as bowel injury, fallopian tube damage, and obtaining hemostasis are discussed. At postoperative follow up, the patient had healed well and was referred back to reproductive endocrinology to start in vitro fertilization treatments. It can be difficult to know preoperatively the extent of adhesive disease in a patient with prior abdominal surgery. Preoperative review of imaging, history, and prior operative reports can help in planning entry. Visualization and skilled intra-operative surgical technique are necessary to perform safe adhesiolysis, enterolysis, and salpingo-ovariolysis.