Incidence Of Postoperative Adhesions Research Articles

Effects of Using Barbed Suture in Myomectomy on Adhesion Formation and Adverse Pregnancy Outcome.

There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.

Value of transvaginal three-dimensional ultrasound in evaluating the curative effect of Yangmo decoction in the treatment of uterine adhesion.

Intrauterine adhesions (IUA) is the damage of the basal layer of the endometrium caused by various reasons, resulting in adhesion of the uterine muscle walls to each other, which is manifested as clinical symptoms such as spanomenorrhea, amenorrhea, and infertility. Hysteroscopic adhesiolysis (HA) is the main treatment, for patients with moderate or severe adhesion or angular adhesion, the incidence of postoperative adhesion is high. Traditional Chinese medicine "Yangmo decoction" can promote endometrial growth. Three-dimensional transvaginal ultrasonography (3D-TVUS) can judge IUA and evaluate uterine receptivity through three-dimensional imaging. This study aims to investigate the value of 3D-TVUS in judging the efficacy of Yangmo decoction in the treatment of intrauterine adhesions. The clinical data of patients who underwent HA at two different centers in department of Gynecology of Third Xiangya Hospital of Central South University and Changsha Jiangwan Hospital from January 2021 to August 2021 were retrospectively collected. A total of 275 eligible patients were included. According to the postoperative management measures, the selected patients were divided into two groups. Yangmo decoction group (n=138): the use of Yangmo decoction and uterine-shaped silicon stent post HA; Hormone group (n=137): the use of estrogen, progesterone and uterine-shaped silicon stent post HA. The preoperative general data, preoperative and postoperative 3D-TVUS parameters of the two groups were analyzed. The endometrial thickness of Yangmo decoction group was thicker than that of hormone group (P<0.001), the intercornual distance was wider (P=0.016), the endometrial echo was more homogeneous (P=0.018), the percentage of bilaterally visible tubal opening was higher (P<0.001), the endometrial morphology was better (P=0.012), and endometrial blood flow, endometrial motility and uterine motion were better in Yangmo decoction group than that in the hormone group (all P<0.001). The endometrial thickness, echo, blood flow, and peristalsis, the number of visible tubal opening, uterine motion, and the intercornual distance obtained by 3D-TVUS examination are important factors to evaluate the prognosis of postoperative drug treatment for IUA. 3D-TVUS is of great significance in evaluating the efficacy of Yangmo decoction in the treatment of IUA.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p &lt; 0.05).&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.&lt;/br&gt.

RISK FACTOR ANALYSIS OF TYPE COLORECTAL OPERATION AND INTRAABDOMEN CONTAMINATION ON EVENT POST OPERATIVE ADHESION: SYSTEMATIC REVIEW AND METAANALYSIS

BACKGROUND: Colorectal surgery is the highest incidence of adhesion-related problems. The type of surgery might be total coletomy, right hemicolectomy, left hemicolectomy, segmental colectomy, Hartmann procedure, and colostomy. Surgical procedures performed on the colon could be contaminated. The most common contamination is faecal contamination. Various causes of peritoneal irritation result in localized brin production, which results in adhesion to the surfaces in contact. PURPOSE: This study focused on the type of colorectal surgery and intra-abdominal contamination on the incidence of postoperative adhesions. METHOD: Systematic review and meta-analysis. We searched for published journal on types of colorectal surgery and contamination with adhesion events published from 2010-2020 using electronic database : Pubmed, Science Direct and Cochrane. RESULT: Ten journals (8 cohort and 2 case control) were included in the meta-analysis. In the risk factors for colorectal surgery: APR surgery, total colectomy and rectal resection had a signicant risk of postoperative adhesions with a pooled odds ratio of 1.74 (95% CI 1 respectively). ,10-2,78); 2.89 (95% CI 2.44-3.41) and 9.91 (95% CI 8.66-11.35). Intra-abdominal contamination also had a risk of adhesions with a pooled odds ratio of 863.47 (95% CI 177.73-4194.13). CONCLUSION: Types of colorectal surgery : APR, total colectomy, and rectal resection and intra-abdominal contamination had a risk of postoperative adhesions.

Incidence of Postoperative Adhesions after Laparoscopic Myomectomy with Barbed Suture

Aim: The aim of the study was to assess the incidence of postoperative adhesion by baseball running suture using barbed suture (BS) in laparoscopic myomectomy in comparison with sutures using an absorbable thread. Methods: Two hundred fifteen patients who underwent second-look laparoscopy (SLL) 6 months after laparoscopic myomectomy at our hospital between 2010 and 2014 were retrospectively reviewed. The incidence, numbers, types, and extent of adhesions were evaluated according to the more comprehensive adhesion scoring method. Propensity score matching (PS) (1:1) between the groups was performed by using the diameter of the largest myoma, the number of enucleated myomas, and the type of adhesion barrier. Results: Running baseball sutures and running sutures were applied to 28 and 187 patients with unidirectional BS and absorbable thread, respectively, to close the incised serosal wounds enucleating largest myomas during laparoscopic myomectomy. After PS matching for the patients, surgical findings and the incidence of postoperative wound adhesions were compared between the groups, including 22 patients each. The surgical findings were similar between the groups, except for the total surgical duration and blood loss (medians), which were significantly shorter and lower in the BS group than in the absorbable thread group (70 vs. 100 min; p = 0.01, 50 vs. 100 mL; p = 0.02). Regarding findings of SLL, no significant differences in the incidence of postoperative wound adhesions were found between the groups (BS, 4/22 [18.2%] versus absorbable thread, 8/22 [36.4%]; p = 0.31). Conclusion: Our data indicated that the incidence of postoperative adhesion following the use of BS for wound closure in laparoscopic myomectomy was similar to that following the use of conventional suture.

The effectiveness of anti-adhesive barrier based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg in various methods of surgical treatment of ectopic tubal pregnancy

Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.

Abstract 21311: A Novel, Shear-Assembling, Shear-Thinning Polymer-Nanoparticle Hydrogel Diminishes Post-Operative Thoracic Adhesions in a Rodent Model of Ischemic Cardiomyopathy

Objective: The incidence of post-operative adhesions is estimated to be 93%, resulting in severe pain, bowel obstruction, infertility, and often requires re-operation. Mainstay adhesion prevention technologies are generally derived from polymer films that serve as physical barriers between scarring tissue and surrounding organs. Yet, these films have not been widely accepted due to their inability to adequately limit adhesions and difficulty handling during surgery. We hypothesized shear-thinning, self-healing polymer nanoparticle hydrogels (PNP) would instead provide a novel, viscoelastic barrier between tissues and organs, allowing tissues to move past each other similar to the body’s natural state, effectively preventing adhesion formation (Fig. 1A). Methods: PNP shear-thinning and self-healing behavior was characterized via rheometry. Adult male Sprague Dawley rats (n=23) underwent sham surgery or permanent ligation of the LAD followed by pericardial application of 250μL PNP gel, 1cm 2 Interceed®--a commercially available adhesion barrier, or no treatment. Degree of adhesion formation, cardiac function, infarct size, and immune response were assessed 4-weeks post infarction. Results: PNP exhibited fast, complete recovery of mechanical properties following network rupture at high strains indicating the reversible and robust nature of the hydrogel system. (Fig. 1B). Infarct size and ejection fraction were controlled to ensure similar inflammatory responses contributing to adhesion formation across treatment groups (1C and D). Treatment with PNP significantly reduced the development of adhesions compared to Interceed and untreated controls (Fig. 1E). Conclusion: Administration of a shear-thinning, self-healing hydrogel reduces the extent of adhesion formation in the thoracic cavity following a thoracotomy and myocardial infarction. PNP provides an easily delivered, scalable solution for post-operative adhesion prevention.

The incidence of post-operative adhesion following transection of uterine septum: a cohort study comparing three different adjuvant therapies

ObjectiveTo investigate the clinical efficacy of postoperative estrogen therapy, intrauterine device (IUD) and intrauterine balloon in preventing intrauterine adhesions after transcervical resection of septum (TCRS). Study design238 patients who underwent TCRS in our hospital from March 2012 to December 2013 were allocated into one of four groups. In Group 1 (50 patients), women received postoperative estrogen therapy. In Group 2 (59 patients), an intrauterine contraceptive device (IUD) was placed into the uterine cavity at the end of the operation. In Group 3 (75 patients), a Foley catheter with the balloon inflated with 4ml of normal saline solution was placed into the uterine cavity at the end of the operation for five days. In Group 4 (54 patients), women did not receive any of the above treatment (comparison group). All subjects underwent two further hysteroscopy, one and three months after the initial surgery. ResultsThe intrauterine adhesion rates among the four groups at one month were 22.0%, 28.81, 26.7% and 24.1% (p>0.05); and at the third month were 0%, 1.7%, 1.3% and 3.4%, respectively (p>0.05). ConclusionsThe use of postoperative estrogen therapy, IUD or intrauterine balloon did not appear to have any benefit in reducing the incidence of postoperative intrauterine adhesion formation.

A Randomized, Multi-Center, Single Blind, Active-Controlled, Matched Pairs Clinical Study to Evaluate Prevention of Adhesion Formation and Safety of HyFence in Patients After Endoscopic Sinus Surgery

ObjectivesRecurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol).MethodsSeventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated.ResultsThere was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05).ConclusionHyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS.

A Modified Technique of Laparoscopic Ovarian Drilling for Polycystic Ovary Syndrome Using Harmonic Scalpel

Objective: To review our experience with a modified technique of laparoscopic ovarian drilling (LOD) using harmonic scalpel as a new energy modality and to compare its effect with electrocautery in managing Clomiphene resistant polycystic ovary syndrome as regard to ovulation rate, pregnancy rate, hormonal profile and ultrasonographic changes that reflect ovarian reserve and reproductive outcome. Patients and methods: Sixty patients presented by infertility due to PCOS were randomly allocated into two equal groups. Group I was subjected to laparoscopic ovarian drilling using electrocautery and Group II were subjected to laparoscopic ovarian drilling using harmonic scalpel. All patients were assessed twice (before the induction procedure and three months later, if pregnancy did not occur). Patients were assessed clinically (to determine menstrual regularity and body mass index), sonographically (to measure ovarian volume and antral follicle count at time of ovarian quiescence) and laboratory (to measure basal serum LH, FSH, LH/FSH ratio, total testosterone and estradiol). Also a 2nd look laparoscopy was performed in those patients who failed to conceive within six months of the initial laparoscopic procedure to assess the presence of adhesion and its type. Results: Laparoscopic ovarian drilling using harmonic scalpel improved menstrual pattern, ovulation rate, pregnancy rate, hormonal profile similar to electrocautery without a significant difference. However it was associated significantly with a minimal effect on ovarian volume, antral follicle count and post operative adhesion. Conclusions: We consider our LOD technique using harmonic scalpel as a new energy modality in managing Clomiphene resistant polycystic ovary syndrome practicable with less extensive destruction of the ovarian capsule and thereby of the ovarian reserve and with minimal incidence of post operative adhesion.

RETIRED: Adhesion Prevention in Gynaecological Surgery

To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery. Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively. Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation. The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease. Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care SUMMARY STATEMENTS: 1. Meticulous surgical technique is a means of preventing adhesions. This includes minimizing tissue trauma, achieving optimal hemostasis, minimizing the risk of infection, and avoiding contaminants (e.g., fecal matter) and the use of foreign materials (e.g., talcum powder) when possible. (II-2). 2. The risk of adhesions increases with the total number of abdominal and pelvic surgeries performed on one patient; every surgery needs to be carefully considered in this context. (II-2). 3. Polytetrafluoroethylene (Gore-Tex) barrier is more effective than no barrier or oxidized regenerated cellulose in preventing adhesion formation. (I). 4. Oxidized regenerated cellulose (Interceed) adhesion barrier is associated with a reduced incidence of pelvic adhesion formation at both laparoscopy and laparotomy when complete hemostasis is achieved. Oxidized regenerated cellulose may increase the risk of adhesions if optimal hemostasis is not achieved. (II-2). 5. Chemically modified sodium hyaluronate/carboxymethylcellulose (Seprafilm) is effective in preventing adhesion formation, especially following myomectomies. There is insufficient evidence on the effect of sodium hyaluronate/carboxymethylcellulose on long-term clinical outcomes such as fertility, chronic pelvic pain or small bowel obstruction. (II-2). 6. No adverse effects have been reported with the use of oxidized regenerated cellulose, polytetrafluoroethylene, or sodium hyaluronate/carboxymethylcellulose. (II-1). 7. Various pharmacological agents have been marketed as a means of preventing adhesions. None of these agents are presently available in Canada. There is insufficient evidence for the use of pharmacological agents in preventing adhesions. (III-C). 1. Surgeons should attempt to perform surgical procedures using the least invasive method possible in order to decrease the risk of adhesion formation. (II-1B ). When feasible, for example, a laparoscopic surgical approach is preferable to an abdominal approach, and a vaginal or laparoscopic hysterectomy is preferable to an abdominal hysterectomy. 2. Precautions should be taken at surgery to minimize tissue trauma in order to decrease the risk of postoperative adhesions. These precautions include limiting packing, crushing, and manipulating of tissues to what is strictly required for safe completion of the procedure. (III-B). 3. Surgeons could consider using an adhesion barrier for patients who are at high risk of forming clinically significant adhesions (i.e., patients who have endometriosis or pelvic inflammatory disease or who are undergoing a myomectomy). If there is a risk of ongoing bleeding from the surgical site, oxidized regenerated cellulose (Interceed) should not be used as it may increase the risk of adhesions in this situation. (II-2B).

Outcome of Septal Resection in Patients with Primary Infertility

Study Objective: Septal resection is well established procedure in recurrent pregnancy loss but its role in primary infertility is not well established. This study highlights the role of septal resection in patients with primary infertility. Design: January 2001 to December 2008 in a prospective cohort study. Setting: Tertiary Fertility Centre. Patients: 123 women with Mullerian anomalies were detected during a eight year period from January 2001 to December 2008 in a prospective cohort study. Intervention: 69 women presented with primary infertility (56.09%) and 54 (43.9%) with secondary infertility. Couples with male factor infertility, secondary infertility, unmarried females and other primary causes of infertility were excluded. These females were subjected to laphysteroscopy after preliminary evaluation. In the study group, 46 women (37.3%) were found to have a septate uterus. Complete septum was seen in 10 (21.2%) and partial septum in 36 women (78.2%). These 46 patients underwent hysteroscopic septum resection using a 26 F resectoscope (Karl Storz) with monopolar cutting current of 40 W intensity. 1.5% glycine was used as distension media. Measurements and Main Results: 16 conceptions (34.7%) occurred in the study group. About 30.4% conceived within 1 year. The rest occured within 4 years after surgery .10 women (21.7%) conceived spontaneously after surgery, 3 conceived following ovulation induction (6.5%). 2 (4.3%) conceived following intrauterine insemination and 1 case (2.1%) following in-vitro fertilization. Conclusion: Hysteroscopic resection of septae restores a normal uterine cavity; has a lower morbidity and incidence of post operative adhesions and improves the conception rates. The hysteroscopic approach to treatment, improved reproductive outcome, has enabled a more liberalized approach to treatment that is now being extended to include not only patients with recurrent pregnancy loss and premature labor but also patients with primary infertility.

An Assessment of the Effects of a Hyaluronan-Based Solution on Reduction of Postsurgical Adhesion Formation in Rats: A Comparative Study of Hyaluronan-Based Solution and Two Film Barriers

Intra-abdominal application of anti-adhesive barriers may reduce the extent and severity of postoperative adhesions. This study was designed to compare the effectiveness of a sprayable liquid barrier (a mixed solution of sodium hyaluronate and carboxymethylcellulose) with two conventional sheets. Eighty male Sprague Dawley rats underwent laparotomy with subsequent multiple intestinal wall abrasions and abdominal wall injury. Afterwards, sodium hyaluronate and carboxymethylcellulose (HA-CMC) solutions were intraperitoneally sprayed or a film barrier of either oxidized regenerated cellulose (ORC) or polylactic acid (PA) was placed under the incision. At postoperative d 21, the rats underwent relaparotomy and complete adhesiolysis. Three investigators, who were blind to the group assignment, scored the extent of adhesion formation and resected specimens for histologic examination of fibrosis and inflammation. Expression profiles of parameters as mediators (macrophages [CD68]) in cellular inflammation response were analyzed. Mean adhesion scores in rats that received HA-CMC solution (7.6±2.3) and ORC membrane (8.1±2.2) were lower than in rats that received PA film (10.7±2.5) and the control group (11.2±2.6) (P<0.05 for each comparison). In addition, there were significantly fewer adhesions located between large and small intestine in the HA-CMC solution group than in the control and each of the film barrier groups (P<0.05 for each comparison). This study suggests that both HA-CMC solution and ORC membrane decrease the overall incidence of postoperative adhesions. However, the mixed solution of HA-CMC appeared to be superior to ORC membrane because this sprayable solution is easy to use and suitable for site-specific adhesion prevention after multifocal bowel trauma.

Incidence of post-operative adhesions following Misgav Ladach caesarean section–A comparative study

Aim. To evaluate the incidence of peritoneal adhesions as a post-operative complication after caesarean section following the Misgav Ladach method and compare it with peritoneal adhesions following traditional caesarean section methods (Pfannenstiel-Dörffler, low midline laparotomy-Dörffler).Methods. The analysis is retrospective and is based on medical documentation of the Clinic for Gynecology and Obstetrics, University Clinical Centre, Tuzla, Bosnia and Herzegovina (data from 1 January 2001 to 31 December 2005). We analysed previous caesarean section dependent on caesarean section method (200 by Misgav Ladach method, 100 by Pfannenstiel-Dörffler method and 100 caesarean section by low midline laparotomy-Dörffler). Adhesion scores were assigned using a previously validated scoring system.Results. We found statistically significant difference (p < 0.05) in incidence of peritoneal adhesions in second and third caesarean section between Misgav Ladach method and the Pfannestiel-Dörffler and low midline laparotomy-Dörffler method. Difference in incidence of peritoneal adhesions between low midline laparotomy-Dörffler and Pfannenstiel-Dörffler method was not statistically different (p > 0.05). The mean pelvic adhesion score was statistically lower in Misgav Ladach group (0.43 ± 0.79) than the mean score in the Pfannestiel-Dörffler (0.71 ± 1.27) and low midline laparotomy-Dörffler groups (0.99 ± 1.49) (p < 0.05).Conclusions. Our study showed that Misgav Ladach method of caesarean section makes possible lower incidence of peritoneal adhesions as post-operative complication of previous caesarean section.

Laparoscopic ventral hernia repair.

A retrospective study was carried out of patients who underwent laparoscopic ventral abdominal wall hernia repair (excluding groin hernias) between January 1994 and January 1999. Laparoscopic ventral hernia repair was performed on 202 patients for defects ranging from 1.5 cm to 12 cm in diameter. Of these, 35 patients had multiple hernial defects. After reduction of the hernial contents and adhesiolysis, a polypropylene mesh was used intraperitoneally in all patients, such that there was a margin of at least 3 cm from the edge of the defect as well as the previous scar. The mean operating time decreased from 90 minutes in the initial 3 years to 50 minutes in the last 2 years. Postoperatively, the mean hospital stay was 1.8 days. Patients complained of somatic abdominal pain at the site of mesh insertion for a mean of 7 days. There were two postoperative hernia recurrences at a mean follow-up of 2.9 years. The incidence of seroma formation postoperatively was 32% in the first 3 years but declined to 18% subsequently with postoperative abdominal-wall pressure dressings. There were no postoperative sequelae related to bowel adhesions. Negligible wound sepsis (superficial wound infection in five patients), decreased morbidity, and all the other advantages of a minimally invasive surgical approach were evident in this group of patients. These promising early results need to be confirmed by a prospective controlled trial, especially recurrence rates and incidence of postoperative adhesions.

Adhesions after laparoscopic myomectomy: effect of the technique used

ObjectiveTo evaluate the technique of laparoscopic myomectomy and to assess the effect of injection of a vasoconstrictive agent on the incidence of postoperative adhesions.DesignProspective randomized clinical study.SettingUniversity‐based and a tertiary referral private centre.Patients38 patients with subserous‐interstitial myomas, 3–7 cm in diameter, who were recruited from 99 women scheduled for laparoscopic myomectomy during the period from September 1994 till March 1997.InterventionsThe patients were randomly assigned to receive an injection of Ornipressin (group I, 21 patients) or no injection (group II, 17 patients) prior to myomectomy.Main outcome measuresThe incidence, type and degree of pelvic adhesions, evaluated at follow‐up laparoscopy 1 month after the original procedure.ResultsThe procedure was easier and less time‐consuming in group I, compared with group II. The incidence of pelvic adhesions was higher in group I compared with group II and the adhesions were more vascular in group I.ConclusionThe technique of laparoscopic myomectomy is feasible and safe. The incidence of postoperative pelvic adhesions is affected mainly by the technique used. Vasoconstricting agents make laparoscopy more convenient to the surgeon, but give a false impression of suitable haemostasis; our preliminary results indicate that their use may increase the incidence of pelvic adhesions.

Tubenzustand nach pelviskopisch operierter (konventionell versus Laser) Tubargravidität

From 1984 to 1988, 136 patients with ectopic pregnancy were treated by endoscopic means. In 29 cases the fallopian tube was removed. In 107 patients conservative treatment was undertaken. The salpingotomy was performed with the endocoagulator and with scissors or using lasers. The postoperative status of the tube was controlled in 54 patients by hysterosalpingography (n = 17) or by second-look laparoscopy (n = 37). In 38 cases the patency test was positive. The incidence of postoperative adhesions was minimal after laser salpingotomy (16%). The complication rate was low (2%).