Early Second-look Laparoscopy Research Articles

Gynecologic use of Sepraspray Adhesion Barrier for reduction of adhesion development after laparoscopic myomectomy: a pilot study

To assess the safety and efficacy of Sepraspray Adhesion Barrier (a modified hyaluronic acid and carboxymethylcellulose powder) after laparoscopic surgery, in view of both the high efficacy of Seprafilm Adhesion Barrier in reducing postoperative adhesions after open surgical procedures and the difficulty with laparoscopic delivery. Multicenter, randomized, reviewer-blinded trial. Reproductive endocrinology and infertility clinics. Women undergoing laparoscopic myomectomy for indications including infertility. Randomization to treatment with (n = 21) or without (n = 20) Sepraspray Adhesion Barrier. Postoperative adhesions development was assessed at early second-look laparoscopy. Adhesions were scored using the modified American Fertility Society scoring system. Surgical procedure duration length was 99 versus 102 minutes in the control versus Sepraspray Adhesion Barrier groups, respectively, with the median number of fibroids removed being two in each group and corresponding fibroid weights of 134 ± 103 versus 113 ± 161 g, respectively. Adhesions scores increased in both the control and Sepraspray Adhesion Barrier groups, with larger although nonstatistically significant increases noted in control subjects when evaluating for the anterior uterus, the posterior uterus, and the entire uterus. Laparoscopic application of Sepraspray Adhesion Barrier after myomectomy in this pilot study was associated with a trend toward a reduction in postoperative adhesion development, as well as an encouraging safety profile. Further evaluation is warranted. Sepraspray Adhesion Barrier #NCT00624930.

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

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.

Preoperative predictors of postsurgical adhesion formation and the Prevention of Adhesions with Plasminogen Activator (PAPA-study): results of a clinical pilot study

To identify predictors of postsurgical adhesion formation in peritoneal fluid and plasma, and assess efficacy and safety of reteplase (recombinant plasminogen activator [r-PA]). Prospective randomized study. University Medical Center. Twenty-six abdominal myomectomy patients with early second-look laparoscopy (ESL). Randomization to IP treatment with 1 mg reteplase in 300 mL Ringer's lactate or 300 mL Ringer's lactate only. Scoring of adhesions and collecting peritoneal fluid during both surgical procedures and collecting plasma samples at ten time points. Incidence, severity, and extent of adhesions at ESL. Concentrations of C-reactive protein (CRP), tissue-type plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), and fibrin degradation products (FbDPs). Significant correlation between the extent of uterine adhesion formation and preoperative plasma levels of CRP (r(s) = 0.558), PAI-1 (r(s) = 0.413), and the change in tPA concentration in peritoneal fluid from initial surgery to ESL (Delta+PA: r(s) = -0.636). No significant differences in adhesion scores between treatment and control groups. Our finding that preoperative plasma CRP and PAI-1-levels are significantly correlated with extent of adhesion formation points to a role of chronic inflammation in the disease process. Results are highly indicative for the paradigm that adhesions are caused by an insufficiency in peritoneal fibrinolytic capacity. For successful adhesion prevention therapy relatively high amounts of r-PA are required.

A comparative study using early second-look laparoscopic evaluation of post-operative adhesion formation between two surgical procedures for polycystic ovarian syndrome

No studies have been performed to evaluate and compare adhesion formation after laparoscopic ovarian drilling with that after ovarian wedge resection by minilaparotomy at the very early stage one week after surgery in women with polycystic ovarian syndrome (PCOS). We investigated adhesion formation after surgical ovarian wedge resection by minilaparotomy (group I; n=37) and laparoscopic ovarian electrodrilling (group II; n=39) in 76 clomiphene citrate-resistant anovulatory infertile women with PCOS. All patients underwent an early second-look laparoscopy one week after operation. Thirty-six women (92.3%) in group II were found to be free of adhesions, whereas 81.1% (30 of 37) of the women in group I had periovarian adhesions. The frequencies of periovarian, intra-abdominal and uterine adhesions in group I were significantly higher than those in group II. There were significant differences in the AFS adhesion scores between group I (9.0±9.7 points) and group II (0.1±0.5 points). After surgery all women ovulated spontaneously or with clomiphene citrate. The pregnancy rate within 1 year after surgery in group II (87.2%) was significantly higher than that in group I (59.5%). The women with PCOS who were treated with laparoscopic ovarian electrodrilling were almost free of postoperative adhesion formation and most of them conceived within 1 year after surgery. This laparoscopic technique should be considered at an early stage in infertile women with PCOS who have failed to respond to clomiphene citrate therapy.

Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma

Background Myomectomy often causes adhesion formation and decreases subsequent fertility. The purpose of the present study was to evaluate the effectiveness of several antiadhesion barrier materials in preventing adhesion after myomectomy. Methods We prospectively classified 63 women undergoing myomectomy alone into four groups according to the type of antiadhesion material used: Hyaluronic acid-carboxymethylcellulose film (Seprafilm ®) ( n = 21, Group 1), Dextran 40 (10% Dextran 40 Low Injection ®) ( n = 17, Group 2), factor 13 with fibrinogen (Beriplast ®) ( n = 12, Group 3) and control ( n = 13, Group 4). We performed early second-look laparoscopy after the seventh post-operative day in all patients and examined adhesion formation in the abdominal cavity. The incidence of adnexal adhesions was evaluated according to the American Fertility Association (AFS) adhesion score. Results The incidence of uterine adhesion was 14.3% in Group 1, 70.6% in Group 2, 75.0% in Group 3 and 76.9% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 2 ( p = 0.0004), Group 3 ( p = 0.0005) and Group 4 ( p = 0.0003). The incidence of peritoneal adhesion was 14.3% in Group 1, 29.4% in Group 2, 41.6% in Group 3 and 69.2% in Group 4. Adhesion formation in Group 1 was significantly less than that in Group 4 ( p = 0.001). AFS scores in Groups 1–4 were 0.38 ± 1.02, 4.58 ± 7.02, 0.83 ± 1.99 and 8.53 ± 8.79 (mean ± S.D.), respectively. Group 1 had the lowest AFS score and the difference between Group 1 and Group 4 was significant ( p < 0.0001). The AFS score in Group 3 was also significantly less than that of Group 4 ( p = 0.0009). Conclusion Seprafilm ® was highly effective and was superior to the other antiadhesion materials tested in preventing uterine adhesions after myomectomy.

Chance of Adhesion Formation after Laparoscopic Salpingo-Ovariolysis: Is there a Place for Second-Look Laparoscopy?

Study Objective To evaluate the chance of adhesion formation after laparoscopic salpingo-ovariolysis and determine the efficacy of early second-look laparoscopy (SLL). Design Prospective, randomized study (Canadian Task Force classification I). Setting Shiraz University hospitals. Subject Ninety women with mean duration of infertility of 7.2 years. Intervention Operative laparoscopy, with early SLL with adhesiolysis in 46 (group 1) and no SLL in 44 women (group 2). Measurements and Main Results Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification. Separation of newly reformed adhesions was performed at the time of SLL. Patients were followed for a year after operation without other infertility treatment. At the time of operation in group 1, adnexal adhesions were graded as severe (class D) in 19 women, moderate (class C) in 31, mild (class B) in 28, and minimal (class A) in 14. Respective figures in group 2 were 10, 30, 34, and 14. After salpingo-ovariolysis these figures were 12, 10, 20, and 50 in group 1 and 6, 14, 17, and 51 in group 2. In group 1 in whom early second-look laparoscopy was performed, at the start of the operation these figures were 17, 20, 21, and 34, and after operation 12, 8, 20, and 52, respectively. There were 11 term pregnancies in group 1and 15 in group 2. No women with severe adhesions in either group conceived. In group 1, chances of term pregnancy were 18.75% for those with moderate adhesions, 35.71% for women with mild adhesions, and 42.86% in patients with minimal adhesions. Respective figures in group 2 were 26.67%, 41.18%, and 57.14%. Conclusion The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2%. Although separation of these adhesions could be performed more easily at the time of early SLL, the chance of pregnancy did not increase compared with that in patients who did not undergo SLL.

Adhesiolysis in early dynamic laparoscopy as the stage of hospital rehabilitation of patients with tubal pregnancy

As many as 48 patients hospitalized with tubal pregnancy were examined and operated. Early second- look laparoscopy with adhesiolysis and chromohydrotubation was performed on the second day of postoperative period to 12 patients, on the third day - to 17 patients and to the rest of patients on the fourth, fifth and seventh day. Repeated adhesiolysis, chromohydrotubation with visual control of uterine tube permeability were performed in third-look laparoscopy. The special titanium trocars were used 2 for early second-look laparoscopy. It is established that second- and third-look laparoscopies make it possible to observe adhesions after surgical intervention and to perform adhesiolysis.

Utility of early second-look laparoscopy after infertility surgery

To evaluate the efficacy of early second-look laparoscopy (ESLL) and the usefulness of the American Fertility Society (AFS) adhesion score at ESLL in terms of reproductive prognosis. Retrospective study (Canadian Task Force classification II-2). University hospital. Ninety-two consecutive women undergoing infertility surgery between January 1983 and December 1996. We performed ESLL in all but 32 patients, 27 of whom underwent surgery before institution of the protocol. The pregnancy rate in 1 year was significantly higher in women having ESLL than in those not having the surgery. The AFS score was not significantly different in pregnant and nonpregnant patients. Early second-look laparoscopy may improve fecundity in women requiring fertility surgery. (J Am Assoc Gynecol Laparosc 6(2):165-168, 1999)

Removal of surgical barriers of expanded polytetrafluoroethylene at second-look laparoscopy was not associated with adhesion formation

Objective: To evaluate whether the surgical trauma required for the laparoscopic removal of a polytetrafluoroethylene (PTFE) surgical barrier would cause postoperative adhesions. Design: Two case reports. Setting: Tertiary academic medical center. Patient(s): Two women who had undergone myomectomy with placement of a PTFE surgical barrier and who were free of adhesions with the barrier in place. Intervention(s): Removal of the PTFE barrier by laparoscopy 11 days after myomectomy. Main Outcome Measure(s): Adhesions at the site of removal of the PTFE barrier at the time of incidental laparoscopy several years later. Result(s): Adhesions were not present at the site of PTFE barrier removal. Conclusion(s): The surgical trauma required to remove PTFE barriers at early second-look laparoscopy was not associated with postoperative adhesions.

Office microlaparoscopy under local anesthesia

We assessed the utility, tolerance, and costs associated with office microlaparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for 100 of the following procedures: diagnostic laparoscopy to evaluate infertility including chromopertubation; diagnostic laparoscopy for chronic pelvic pain (CPP), including biopsy of endometriosis and conscious pain mapping; and early second-look laparoscopy including lysis of adhesions. A prospective nonselected cohort study was conducted on all women with CPP or infertility who consented to office microlaparoscopy under local anesthesia. A questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with modification of the McGill pain inventory relative intensity scale. A subset of questions evaluated the recovery period, and time and length of all aspects of the procedure and recovery were recorded. Second-look procedures were significantly more painful than diagnostic ones, and women with CPP experienced significantly greater pain than those with infertility. Virtually all expressed high satisfaction with the procedure. There were no complications, and no procedures required general anesthesia. Compared with traditional laparoscopy, there was a reduction in costs greater than 70%.

Results of microsurgical treatment of tubal infertility and early second-look laparoscopy in the post-pelvic inflammatory disease patient: Implications for in vitro fertilization

International Journal of Gynecology & ObstetricsVolume 25, Issue 4 p. 342-342 Citations from the literature fertility and sterility Results of microsurgical treatment of tubal infertility and early second-look laparoscopy in the post-pelvic inflammatory disease patient: Implications for in vitro fertilization K Luber, K LuberSearch for more papers by this authorCC Beeson, CC BeesonSearch for more papers by this authorJF Kennedy, JF KennedySearch for more papers by this author K Luber, K LuberSearch for more papers by this authorCC Beeson, CC BeesonSearch for more papers by this authorJF Kennedy, JF KennedySearch for more papers by this author First published: August 1987 https://doi.org/10.1016/0020-7292(87)90302-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume25, Issue4August 1987Pages 342-342 RelatedInformation

A clinical study of the CO2 laser and electrosurgery for adhesiolysis in 172 cases followed by early second-look laparoscopy

A clinical study of the CO2 laser and electrosurgery for adhesiolysis in 172 cases followed by early second-look laparoscopy

Laparoscopic assessment of ovarian healing following CO2 laser microsurgery: Vicryl vs. Surgilon.

A prospective multicenter study was undertaken by the Intraabdominal Laser Study Group to assess the type and extent of ovarian adhesions formed following incisional ovarian surgery performed as part of a fertility-promoting procedure with the aid of the carbon dioxide laser. Ovarian healing with subsequent adhesion formation was evaluated by early second-look laparoscopy. Two suture closing materials were used--Surgilon (siliconized braided nylon, David and Geck, Wayne, NJ) and Vicryl (polyglactin 910, Ethicon, Somerville, NJ). Sixty-five ovaries were evaluated in 37 patients with subsequent adhesions found in 37% (18/49) of the Surgilon-closed ovaries and in 94% (15/16) of the Vicryl-closed ovaries. The adhesions were filmy in 83% (15/18) of the Surgilon group and 47% (7/15) of the Vicryl group. Dense/vascular adhesions were found in 17% (3/18) of the Surgilon group and 53% (8/15) of the Vicryl group. The subsequent conception rates were 68% (17/25) in the Surgilon group and 33% (4/12) in the Vicryl group, although the small number of patients and multitude of infertility factors made pregnancy rate comparisons difficult. One of the authors noted lack of tensile strength in the Vicryl-closed ovaries within 12 weeks postlaser laparotomy, which led to incisional dehiscence during laparoscopic lysis of ovarian adhesions. From this preliminary study, it is concluded that additional data are needed to more fully resolve the debate on whether absorbable or nonabsorbable suture is preferred for ovarian infertility surgery.

Clinical results of terminal salpingostomy with the use of the CO2 laser: report of the intraabdominal laser study group

Forty-eight women underwent terminal salpingostomies with a standard operative procedure with the use of the CO2 laser and microsurgical techniques at five centers. Early second-look laparoscopy was performed in all patients 1 to 12 weeks after the laparotomy. The tubal patency rate at the second look was 92% for these 48 patients, with a minimum of 6 months' follow-up study in all patients. Of these patients, ten became pregnant (21%), one with an ectopic pregnancy (10%). All pregnancies occurred within 12 months of the second-look procedure. It is preliminarily concluded from this series that use of the CO2 laser for neosalpingostomy at laparotomy with early second-look laparoscopy provides a term pregnancy rate similar to that previously achieved by nonlaser microsurgical techniques and shortens the time period between the surgical procedure and when conception would be expected to occur.

Tubal patency and pelvic adhesions at early second-look laparoscopy following intraabdominal use of the carbon dioxide laser: initial report of the intraabdominal laser study group

It has been suggested that the carbon dioxide (CO2) laser, by virtue of its hypothetical capabilities for precise incisions, minimization of tissue handling and bleeding, and shortened operating time, may improve the success rate of gynecologic infertility surgery. To assess this hypothesis, a multicenter prospective study was performed to assess tubal patency and adhesion formation at early second-look laparoscopy after intraabdominal laser surgery. Procedures performed included salpingoneostomy, fimbrioplasty, lysis of adhesions, vaporization of endometriosis, and ovarian wedge resection. The results were compared with those of another multicenter prospective study that utilized nonlaser reconstructive pelvic surgery. Use of the CO2 laser was found to result in a greater tubal patency rate at the time of the second-look procedure. Adhesions present at the time of the second-look procedure were reduced from initial presentation at most sites; however, nonlaser infertility surgery appeared to have equal or greater efficacy in the prevention of adhesion formation at most sites. Thus, the CO2 laser does not appear to be a panacea for the treatment of tuboperitoneal causes of infertility. Pregnancy rates following intraabdominal use of the CO2 laser remain to be established.

Evaluation of adhesion reformation by early second-look laparoscopy following microlaser ovarian wedge resection

Early second-look laparoscopy, done 6 to 12 weeks postoperatively, was utilized to evaluate recurrent adhesion formation following microlaser ovarian wedge resection. Forty-nine ovaries in 25 consecutive infertility patients undergoing microlaser surgery for deep ovarian endometriosis or polycystic ovarian disease, refractory to medical treatment, were evaluated from October 1981 through March 1983. All patients subsequently underwent a second-look nonlaser laparoscopy to evaluate the extent of healing and to bluntly lyse any subsequent adhesions with the Olympus laparoscope (Olympus Corporation, Lake Success, NY) second-puncture probe: 36.7% of the ovaries had recurring adhesions, 83.3% of these adhesions were mild and filmy and 16.7% were moderate and dense. Additionally, four ovaries were viewed approximately 1 year postoperatively, with two ovaries that previously had mild and filmy adhesions lysed at 6 weeks having no recurrent adhesions. The actual pregnancy rate in this study is 60%, with 15 of the 25 patients conceiving at least once and 2 patients conceiving twice. The majority of pregnancies occurred within the first 6 months postoperatively, with the longest initial pregnancy occurring 22 months postoperatively. Thus, microlaser ovarian surgery, coupled with early second-look laparoscopy, appears efficacious in minimizing adhesion reformation and seems to have little adverse effect on subsequent conception.