Evaluation of Adhesion Formation after Laparoscopic Myomectomy by Systematic Second-Look Microlaparoscopy

Abstract

Study Objective To evaluate adhesion formation after laparoscopic myomectomy by second-look laparoscopy using a microlaparoscope. Design Prospective, nonrandomized study. (Canadian Task Force classification II-1). Setting University hospital. Patients One hundred fifteen women who underwent laparoscopic myomectomy and 51 who underwent second-look minilaparoscopy. Intervention Laparoscopic myomectomy, in which fibrin glue spray was applied to prevent postoperative adhesion formation, and second-look laparoscopy. Measurements and Main Results The mean interval between surgeries was 5.1 ± 3.0 months (range 2–18 mo). The mean size of enucleated myomas was 6.1 ± 1.5 cm (range 3.0–10.5 cm), and mean number of myomas removed/patient was 3.0 ± 2.2 (range 1–9 myomas). At assessment of 152 myomectomy sites, the rate of adhesions was 29.4%/patient and 11.2%/myomectomy site. Risk factors that influenced adhesion formation were posterior location and intramural myoma. In most cases the organ adhered to the myomectomy site was sigmoid colon. The frequency of adnexal adhesions was 17.6%/patient and 9.8%/site. Conclusion The rate of adhesion formation after laparoscopic myomectomy was low, and routine second-look microlaparoscopy was useful to evaluate the efficacy of the first surgery.