Pelvic Adhesions Research Articles

Reassessment of prevalence of tubal endometriosis, and its associated clinicopathologic features and risk factors in premenopausal women received salpingectomy.

IntroductionTo reassess the prevalence of fallopian tube endometriosis (EM), and its associated clinicopathologic characteristics and risk factors.MethodsCross-sectional study was conducted from June 2016 to August 2017. Unpregnant premenopausal women who underwent unilateral or bilateral salpingectomy due to gynecologic diseases were recruited. Patient clinical data and fallopian tube specimens were collected. Hematoxylin-eosin (H&E) staining and CD10 immunohistochemistry were used to diagnose tubal EM.ResultsTubal EM prevalence was 14.48% (161/1112, 95% confidence interval [CI] 12.41%–16.55%). Prevalence of tubal EM in patients with EM was 37.37% (95%CI 30.58%–44.17%) which is higher in patients without EM (9.52%, 95%CI 7.61%–11.42%) and even higher in those with multi-organ EM (43.94%, 95%CI 35.36%–52.52%). At unilateral or bilateral salpingectomy, tubal EM was more likely located in the left fallopian tube (52.17%) than the right one (40.37%) and presence of hydrosalpinx/ hematosalpinx increased in women with tubal EM than without tubal EM (43.47% versus 23.79%). With increasing severity of pelvic EM (r = 0.26, P<10−4) and adhesion (r = 0.25, P<10−4), the tubal EM prevalence also increased. Pathological examination found that tubal EM was more likely located in the mucosa of the proximal tube with significantly more surrounding inflammation and fibrotic lesions than the serosa/sub-serosa in the distal tube (r = 0.90, P<10−4). Multivariate analysis showed that abnormal uterine bleeding (AUB) (AOR = 3.10), previous EM surgery (AOR = 4.22) and tubal ligation (AOR = 2.33) were risk factors for tubal EM.ConclusionsThese data provide clinicians with important information that the prevalence of tubal EM among premenopausal unpregnant patients was higher than previous investigators, especially higher among women with EM diseases. Identifying its clinicopathologic characteristics and predictors may facilitate clinical decision making.

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

IPEG 2019 The 28th Annual Congress for Endosurgery in Children March 20-22, 2019, Santiago, Chile.

A case of obstructed hemivagina and ipsilateral renal anomaly syndrome complicated with pyometra: tips and tricks for laparoscopic hemihysterectomy

A case of obstructed hemivagina and ipsilateral renal anomaly syndrome complicated with pyometra: tips and tricks for laparoscopic hemihysterectomy

Comprehensive Surgical Staging in Stage 1 Clear Cell and Endometrioid Ovarian Carcinomas: Is it Necessary?

The objective of this article was to evaluate the presence of occult metastasis after comprehensive surgical staging of clear cell ovarian carcinoma (CCC) and endometrioid ovarian carcinoma (EMCA) that appeared to be confined to the ovary at time of surgery. Between 1998 to 2016, 85 patients with CCC and EMCA were identified who were comprehensively staged and felt to be stage 1 intraoperatively. Of the 85 patients who underwent surgical staging, 4 (4.7%) had omental and dense pelvic side-wall tumor adhesions. On final pathology, 67 (79%) patients were diagnosed as stage 1A of which 29 (43%) patients were upstaged to 1C1 due to intraoperative rupture. The remaining 18 (21%) patients were staged as 1C2/1C3. The 1- and 5-yr disease-free survival for pathology stage 1A tumors was 94% and 76%, respectively, and for 1C2/1C3 tumors was 100% and 75%, respectively. Among patients who received adjuvant chemotherapy, the 5-yr disease-free survival was near equal for pathology stage 1A and 1C2/1C3 groups (73% vs. 74%), with a lower 5-yr disease-free survival for CCC compared with EMCA (72% vs. 78%). There were 16 (19%) recurrences with 12 being pathology stage 1A. Of these 12 patients, 9 (75%) had CCC of which 2 received adjuvant chemotherapy. Even in the presence of dense adhesions (4.7%), the likelihood of extraovarian disease in CCC and EMCA confined to the ovary was very low. Accordingly, the findings in this study indicate that comprehensive surgical staging for what appears to be stage 1 CCC and EMCA may provide no benefit in detecting occult disease that would upstage the tumor.

The role of diagnostic laparoscopy in the era of modern imaging techniques: a study from a single center

Background: Despite the tremendous progressive evolution in the field of medicine, wherein, most of the diseases can be diagnosed based on history, clinical examination and investigations, there are quite a number of diseases which remain undiagnosed. It is here, where the role of diagnostic laparoscopy becomes important to reach to a conclusion for further management of patients.Methods: This study comprising of 70 patients undergoing diagnostic laparoscopy at SKIMS over a period of 4 years. This study was done to evaluate the role of diagnostic laparoscopy in patients with acute and chronic abdominal conditions wherein final diagnosis could not be achieved after all necessary imaging, serological, cytological, and microbiological investigations.Results: Out of 70 patients subjected to diagnostic laparoscopy in our study, the commonest indication was as cites of undetermined etiology (42.9%) followed by chronic abdominal pain (25.7%) diffuse liver disease (11.4%) acute abdominal pain (SAIO, cholecystitis, acute appendicitis, PID, endometriosis) (5.7%) abdominal tuberculosis (4.3%) focal liver disease (2.9%) bleeding per rectum (2.9%) abdominal malignancy (2.9%) and primary infertility (1.4)%. The post diagnostic laparoscopy outcome (final diagnosis) were abdominal malignancy 22 (31.4%) followed by abdominal tuberculosis 16 (22.9%) diffuse liver disease 6 (8.6%) focal liver disease 6 (8.6%) PID 4 (5.7%) SAIO 4 (5.7%) post-operative pelvic adhesions 3 (4.3%) Meckel’s diverticulum 2 (2.9%) abdominal plus pulmonary tuberculosis 1 (1.4%), endometriosis 1 (1.4%), ovarian cyst 1 (1.4%), pseudomyxoma peritonei 1 (1.4%), chronic appendicitis 1 (1.4%) and inconclusive 2 (2.9%). Diagnostic laparoscopy confirmed pre-operative diagnosis in 10 (14.3%) patients. In 29 (41.4%) patients pre-operative diagnosis was corrected by diagnostic laparoscopy. In 29 (41.4%) patients diagnosis was made only after diagnostic laparoscopy.Conclusions: Diagnostic laparoscopy is a safe, quick, and effective adjunct to non surgical diagnostic modalities, for establishing a conclusive diagnosis with high percentage of accuracy in diagnosis and impact in further management in selected patients.

The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization.

The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients’ diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.

Application of hysteroscopy combined with laparoscopic pelvic exploration in the diagnosis and treatment of primary and secondary infertility

Objective To observe the different manifestations and differences of pelvic laparoscopy in primary and secondary infertility patients, and to clarify the application of hysteroscopy combined with laparoscopy in the diagnosis and treatment of infertility. Methods A total of 120 infertile women were enrolled in Yiwu Central Hospital from January 2015 to January 2017, of which 66 cases were primary infertility and 54 cases were secondary infertility. The infertility group was divided into 1 time, 2 times, 3 times and above according to previous maternity. Hysteroscopy combined with laparoscopy was used for pelvic exploration in infertility patients. The detection of the type of disease, pelvic adhesions, tubal fluid and treatment were analyzed. Results (1)Infertile patients were complicated with endometriosis, pelvic tuberculosis, polycystic ovary, uterine fibroids, ovarian tumors, endometrial polyps and other diseases. (2)There were 94 cases of pelvic adhesions(78.3%), 50 cases of primary infertility(75.8%), and 44 cases in Secondary infertility group(81.5%). (3) Primary infertility adhesion ratio of 75.8%, secondary infertility adhesion ratio of 81.5%, the proportion of adhesions in maternal 1 time patients was 80.6%, the proportion of adhesions in pregnant women with 2 times was 83.3%, the proportion of adhesions in pregnant women with more than three times was 90.0%, and the median adhesion rate was 36.4% in the secondary infertility cases, the proportion of severe adhesion was 45.5%. (4) Intraoperative treatment of tubal fluid examination conducted in 240 strips.The probability of recanalization of the primary infertility group was 17.78%, and the probability of recanalization was 18.75%. Conclusion (1) Pelvic adhesion is an important factor in causing infertility, primary infertility patients also have a greater proportion of pelvic, fallopian tube disease.(2) Repeated maternal history significantly increased pelvic, fallopian tube disease, which is an important factor caused the increased incidence of secondary infertility. Key words: Infertility, female; Hysteroscopy; Laparoscopy; Tissue adhesions; Pelvic inflammatory disease; Fallopian tube diseases

Are the cesarean section skin scar characteristics associated with intraabdominal adhesions located at surgical and non-surgical sites

ObjectiveTo investigate whether skin scar characteristics are associated with the presence and severity of abdominal or pelvic adhesions in women who have undergone previous cesarean section. MethodsIn this prospective study, 104 women who had undergone at least one previous cesarean section and were scheduled for laparoscopic surgery due to benign gynaecologic indications were included. Preoperative skin scar characteristics as well as intraoperative adhesions were evaluated using the modified Manchester Scar Scale and the Peritoneal Adhesion Index, respectively. ResultsDuring laparoscopic surgery, adhesions were detected in the upper region of the abdominal cavity in 30 women, in the middle region in 46 women and in the lower region in 82 women. Total abdominal scar scores were significantly increased in women with adhesions in all three adbominal regions. Multiple cesarean section scars and palpable scars were more common in women with adhesions. Significant positive correlations were found between the skin scar and adhesion scores in all abdominal regions. ConclusionThe skin scar characteristics of the previous caesarean section are associated with the presence and severity of pelvic and abdominal adhesions. Skin scarring especially with palpable texture may be an indicator of adhesion formation in the entire abdominopelvic cavity.

Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery.

Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy.We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8–15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed with t test, Chi-Square test, ANOVA or ROC as appropriate.Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis (P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients (P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) (P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%.The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.

In vivo expression of thrombospondin-1 suppresses the formation of peritoneal adhesion in rats.

BACKGROUNDFormation of intraperitoneal adhesions is one of the major complications after abdominal surgery, which may lead to bowel obstruction. Thrombospondin 1 (TSP-1) is an extracellular matrix modulating glycoprotein during tissue regeneration and collagen deposition.AIMTo evaluated the therapeutic potential of overexpressed TSP-1 in suppressing pelvic adhesion formations in rat models.METHODSPelvic adhesion was induced in anesthetized rats by laparotomy cecal abrasion. The animals were randomly assigned to treatment of local application with Seprafilm (an antiadhesive bioresorbable membrane) or adenoviral vectors encoding mouse TSP-1 (AdTSP-1) on the surfaces of the injured cecum. The severity of the peritoneal adhesions was evaluated by blinded observers 14 d later.RESULTSCompared with control (no treatment) group, the application of Sperafilm significantly reduced the formation of adhesion band, and local administration of AdTSP-1 on the injured cecum the also attenuated the severity of peritoneal adhesion score. However, systemic delivery of AdTSP-1 did not affect the formation of adhesion.CONCLUSIONWe conclude that therapeutic approaches in inducing regional overexpression of TSP-1 may serve as alternative treatment strategies for preventing postoperative peritoneal adhesion.

Gastrointestinal injuries during gynaecologic operations at a university teaching hospital in Thailand: a 10-year review

The objective of this study was to investigate the incidence of gastrointestinal injuries during gynaecologic operations, the management of such injuries and associated risk factors. This case-control study (1:4) examined patients who received gynaecologic operations from 2007 to 2016 in Ramathibodi Hospital. The study cases comprised patients who had gastrointestinal injuries, while the control cases comprised patients who had gynaecologic surgeries in the same period with matching the types of procedures. The 10-year incidence was 0.38% (104 cases of gastrointestinal injuries among a total of 27,520 cases). The most common injury site was the small bowel (43.3%). There were 102 cases (98%) of gastrointestinal injuries which were diagnosed intraoperatively and which were immediately repaired with successful outcomes. Logistic regression indicated that a pelvic adhesion, previous pelvic surgery and previous abdominal surgery were predictive risk factors associated with the injuries (odds ratios: 9.45, 3.20 and 11.84, respectively). An immediate consultation with a surgeon and surgical repair of the injury resulted in excellent outcomes.Impact statementWhat is already known about this subject? Gastrointestinal injury is a rare, but fatal complication of gynaecologic operations. The previous small study identified some risk factors such as surgical approach and pelvic surgery associated with the injury.What do the results of this study contribute? Our study identified the associated risk factors for gastrointestinal injury, including previous abdominal injury, pelvic adhesion and previous pelvic surgery. A previous abdominal surgery was the most associated risk factor. Patients with the history of abdominal surgery had an almost 4-fold higher odds ratio than the ones with previous pelvic surgery. Other factors, including endometriosis, ovarian cancer and subsequent oncological procedures, and surgical staging were less related to the gastrointestinal injury.What are the implications of these findings for clinical practice and/or further research? The knowledge is useful for pre-operative evaluation and preparation. Bowel preparation and consultation with surgeon are necessary for patients with these risk factors prior to their surgeries. Moreover, an immediate intra-operative surgical correction of the injury results in excellent outcomes.

Role of laparoscopy in the diagnosis of chronic pelvic pain

Introduction: Chronic pelvic pain (CPP) is noncyclic pain of 6 or more months' duration that localizes to the anatomical pelvis, anterior abdominal at or below the umbilicus, and the lumbosacral and is of sufficient severity to cause functional disability. Lower abdominal pain can be caused by chronic pelvic inflammatory disease, pelvic adhesions, certain ovarian cysts, pelvic vascular congestion, uterine fibroids, and adenomyosis, but pain arising from organs outside the pelvis may also radiate to the lower abdomen. Only 20%–25% of patients respond to conservative management. When such treatment fails, a diagnostic laparoscopy is usually performed. Aim: We aim to study the role of laparoscopy in the diagnosis of CPP. Objective: The objective was (1) to evaluate the causes of CPP by diagnostic laparoscopy and (2) to compare the clinical finding and ultrasound findings with laparoscopic findings. Materials and Methods: The present study includes fifty patients presented with lower abdominal pain of at least 6-month duration. A detailed history was taken about the pattern of the pain and its association with other problems. Gynecological examination included inspection of the vulva and perineum, speculum examination of the cervix and vagina, bimanual examination to assess the shape, size, direction, mobility of the uterus and adnexa, mass and tenderness of the urethra, vaginal fornix and cervical motion tenderness. The patients were further evaluated by ultrasound examination (transvaginal and abdominal) and diagnostic laparoscopy. Results: Most of the women were of the mean age group of 29.30 years. The pain was most commonly associated with dysmenorrhea in 76% of the patients. Nine patients out of 26 who showed normal findings on bimanual examination revealed abnormal findings on laparoscopy. Five patients out of 22 who showed normal findings on ultrasonography showed abnormal findings on laparoscopy. Conclusion: Laparoscopy is a gold standard tool in the evaluation of women with CPP because diagnosis and treatment can be done in the same sitting.

Pattern of hysterosalpingographic findings among infertile women at a tertiary hospital in North West, Nigeria

Background: Infertility is a global public health problem, with the highest prevalence in sub-Saharan Africa where infection-related tubal damage is the commonest cause. Hysterosalpingography (HSG) is the first line investigation in the evaluation of tubal patency.Objectives: The study was performed to assess the prevalence and pattern of HSG findings in patients who went through infertility clinic at Aminu Kano Teaching HospitalMethodology: It was a retrospective study of the HSG findings among infertile women at the infertility clinic of Aminu st st Kano Teaching Hospital between 1 January 2016 to 31 December 2017.Results: Majority of the patients had normal HSG findings (55.6%, n=124). The commonest abnormality was bilateral tubal blockage with or without hydrosalphinx (25.6%, n=57). Other abnormalities include right tubal blockage only (3.6%, n=8), left tubal blockage only (2.2%, n=5), right hydrosalphinx (13.5%, n=30), left hydrosalphinx (10.8%, n=24), intrauterine adhesions (6.7%, n=15), uterine fibroids (4%, n=9), pelvic adhesions (8.1%, n=18) and congenital uterine anomalies (1.3%, n=3).Conclusion: The commonest abnormality on HSG among infertile patients at the gynaecology clinic was bilateral tubal blockage with or without hydrosalphinx which are usually infection related . Prompt diagnosis and treatment of sexually transmitted infections and other pelvic infections will therefore go a long way in preventing tubal damage and the dreaded sequelae of infertility.Keywords: Hysterosalpingography, Infertility, Kano

GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus.

Background and Objectives:Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa).Methods:We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects.Results:Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence.Conclusions:GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious.

Ozone therapy: a potential therapeutic adjunct for improving female reproductive health.

Ozone is emerging as a new adjunct therapeutic agent for female infertility. We here present a review of the literature, to date, pertaining to the effect of ozone therapy on tubal, ovarian, endometrial, and vaginal factors that could potentially affect female fertility. It also presents data pertaining to the relationship of ozone therapy on pelvic adhesion formation. Most data were performed on animals and very few human studies existed in the literature. Results suggested that ozone therapy could have beneficial effect on tubal occlusion, could protect from endometritis and vaginitis, might protect ovaries from ischemia and oocyte loss and finally might lead to less formation of pelvic adhesions. There is a critical need for human studies pertaining to ozone therapy, especially using safe methods of administration, such as transdermally or intravaginally, on female fertility.

A 5-year audit of diagnostic gynaecologic laparoscopy under conscious sedation at the university college hospital, Ibadan

Introduction: Diagnostic laparoscopy affords smaller incisions, shorter recovery time, and fewer complications. In developing countries, access is limited by cost, infrastructural deficit, and expertise. In a bid to reduce cost at our center, conscious sedation for diagnostic laparoscopy was introduced as far back as 1980. We present here a 5-year audit of our outpatient diagnostic laparoscopy highlighting the various indications, findings, and complications observed. Methodology: A retrospective review of case files of patients who had diagnostic gynecological laparoscopy between 1st January 2011 and 31st December 2015. The retrieved case files had data extracted and analysed using the Statistical Package for Social Sciences version 20 (Chicago IL USA). Data was presented as simple percentages using tables and figures. Results: During the period, 1,329 outpatient gynecological procedures were performed with 207 diagnostic gynecologic laparoscopies (15.6%). Only 187 case notes were retrieved (retrieval rate of 90%). The mean age was 33.04 (±5.2) years, 84.5% (158) had post-secondary education, and 69.0% (129) were nulliparous. Majority, 131 (70.0%), had laparoscopy and dye test, 26 (14.0%) had laparoscopy alone, and 30 (16.0%) had a combination of laparoscopy, dye test, and hysteroscopy. The commonest indications were secondary infertility (51.9%), primary infertility (24.1%), and chronic pelvic pain (11.2%). Common findings at laparoscopy were pelvic adhesions (53.5%), uterine fibroids (35.1%), and bilateral tubal blockage (30.3%). Normal findings were reported in only 19 patients (10.3%). Conclusion: Diagnostic laparoscopy under conscious sedation is cost-effective and safe. It has very minimal complications when performed by skilled personnel. It is thus recommended for low resource settings with the view to avail low income patients the opportunity for endoscopic evaluation.

Hysterosalpingographic Findings among Patients Undergoing Infertility Work-Up in Kisangani, Democratic Republic of the Congo

Introduction: Hysterosalpingography is an important tool in the investigation of the causes of female infertility. In developing countries such as the Democratic Republic of Congo, the HSG is the basic tool for performing first-line anatomical (pelvic) assessment. The aim of this study is to determine the prevalence of the different lesions observed in hysterosalpingography carried out during the assessment of infertile women monitored in Kisangani. The study set also out to look for differences in these lesions according to the type of infertility. Methods: This cross-sectional study was conducted in Kisangani from June 2016 to December 2018. The 130 cases of hysterosalpingography performed for female infertility assessment during the study period were included, of which 33.07% for primary infertility and 66.93% for secondary infertility. Results: The mean age of the patients was 33.52 ± 6.01 years; the history of pelvic inflammatory disease was noted with a predominance for secondary infertility (11% vs. 4.65%). Using hysterosalpingography, 7 (5.38%) patients had a normal result; 94 (72.31%) had tubal obstruction; 25 (19.23%) had hydrosalpinx; 11 (8.46%) had uterine fibroids; pelvic adhesions were suspected in 12.64% of cases. There was no obvious association between all these lesions and the type of infertility. Conclusion: We found that tubal obstructions were the most prevalent lesions in this study, regardless of the type of infertility. These lesions would reflect the high prevalence of septic abortions and sexually transmitted infections in developing countries such as the Democratic Republic of the Congo.

Laparoscopy and the Era of ART in Unexplained Primary Infertility: Randomized Clinical Trial

OBJECTIVES: To compare the outcomes (effectiveness and safety) of laparoscopic surgery as a treatment option of unexplained primary infertil-ity with ART. DESIGN: Randomized prospective clinical trial. PATIENTS AND METHODS: 536 patients with primary unexplained infertility diag-nosed by normal hormonal profile and ovulatory at ovulation testing, nor-mal HSG, and normal semen analysis were randomized according to com-puter based system into: group I, 267 patients were managed with laparos-copy with aim of diagnosis and treatment. While in group II, 269 patients were treated by controlled ovarian stimulation and IUI up to 3 trials, if failed ICSI was performed. We calculated cumulative pregnancy outcome after two years for each group. RESULTS: In group I, Laparoscopic find-ings were as follow: minimal to mild endometriosis was found in 83 cases (31.1%), moderate to severe endometriosis 44 cases (16.5%) managed by adhesiolysis and ablation-excision of endometriotic implants. The preg-nancy rate after two years was 55.4% (46 cases), 38.6% (17 cases) in both respectively, significant periadnexal and pelvic adhesions 41 cases (15.3%) managed by adhesiolysis with pregnancy occurred in 22 cases (53.7%), while laparoscopy revealed hypo plastic tubes 33 cases (12.4%), and 66 cases (24.6%) remained unexplained. With the expectant manage-ment, pregnancy rate was 21.2% (7 cases), and 15.2% (10 cases) respec-tively. The overall pregnancy rate in group I is 102 cases (38.2%). In group II, 114 cases (42.3) got pregnant as 27 cases (8.78%) by IUI, and 87 cases (33.52%) by ICSI. OHSS occurred in 3 cases, multiple pregnancy occurred in 13 cases, abortion and miscarriage 6 cases in group II, while 2 cases of ectopic pregnancy in group I, and the patients of both groups did not suffer any significant operative complications. CONCLUSION: Laparoscopy is safe and effective as a treatment option in unexplained infertility and its performance provides diagnostic findings which are valuable in manage-ment of the unidentified causes, enabling good number of patients to have pregnancy spontaneously which is comparable to ART while avoiding economic, psychological and physical burdens of ART, like OHSS, multi-ple pregnancy and abortion which are higher in cases treated with ART. In the future if ART is needed, the success rate is increased by closure of (undiagnosed) hydrosalpinx and reposition of the ovary to facilitate oocyte retrieval.

Impact of Endometriosis-Related Adhesions on Quality of Life among Infertile Women.

BackgroundEndometriosis is considered the most common cause of pelvic adhesions in women. Endometriosis- associated adhesions could result in the formation of fibrous bands, which contain endometriotic glands, stroma and scarring. The aim of this study was to identify the impact of endometriosis-related adhesions on quality of life among infertile women.Materials and MethodsThis descriptive study was conducted at Endoscopic Unit, in Zagazig University Hospitals, Egypt. Oral consent for participation in this study was taken from 109 women who were candidates for laparoscopy as infertile cases and were diagnosed with endometriosis. They were classified into two groups namely, group I (n=41) who had endometriosis with adhesions and group II (n=68) who had endometriosis without adhesions. A structured interviewing form, adhesion scoring method of the American Fertility Society, and Global Quality of Life Scale were used to collect required information.ResultsThe prevalence of adhesions resulted from endometriosis was 37.6%. Demographic characteristics of the women with endometriosis-related adhesions were not significantly different from those of women without endome- triosis-related adhesions. The most common location for endometriotic adhesions was adnexal adhesion (51.2%) fol- lowed by adhesion of anterior abdominal wall (24.4%). Quality of life was significantly impacted by endometriosis- related adhesions (P=0.002).ConclusionA high percentage of studied patients had a moderate degree of adhesions. Adhesions caused by endo- metriosis had an impact on quality of life of the studied women.

Transvaginal ultrasound (USTV) for Deep Pelvic Endometriosis: How “To Do” do it

Endometriosis is characterized by the growth of endometrial tissue outside the uterine cavity. The standard gold diagnosis for endometriosis is the surgery. For surgical planning, the imaging diagnosis is fundamental to obtain complete excision and patient's treatment. The transvaginal ultrasounds after bowel preparation should be the first line in the diagnosis and endometriosis staging. The hiperechoic uterus serosa must be seen intact. Looking for pelvic adhesions, the ovary often is fixed to the uterus. Vaginal gel before the exam helps to detect small lesions. Intestinal Lesions: perform after bowel preparation, provide the lesions size, wall layers infiltration degree, circumference of bowel involvement and the distance from the anal verge to the inferior lesion margin. Bladder: minimal amount of urine in the bladder to study the vesical wall. The aim of this study is to describe and illustrate radiologic signs, surgery and pathologic correlations of deep endometriosis, from a reference Center, presenting a pre surgical protocol study using ultrasound technique.