Postoperative Pelvic Adhesions Research Articles

Global recommendations on adhesion prophylaxis in gynaecological laparoscopic surgery.

Adhesions are recognised as one of the most common complications of abdominal surgery; their diagnosis and prevention remains a significant unmet need in surgical therapy, affecting negatively a patient's quality of life and healthcare budgets. In addition, postoperative pelvic adhesions pose a high risk of reduced fertility in women of childbearing age. These 2023 Global Recommendations on Adhesion Prevention in Gynaecological Laparoscopic Surgery provide agreed-upon statements to guide clinical practice, with the ultimate goal of improving patient outcomes.

Two natural materials found to reduce adhesion formation in a rat uterine horn model

Background/Aim: Post-operative pelvic adhesions cause various problems in patients, pose surgical difficulties to clinicians, and an increase in health costs. We compared the effectiveness of two natural materials, Trehalose (TRZ), Human Amnion Fluid (HAF), with oxidized regenerated cellulose (ORC) in terms of adhesion prevention after gynecological operations. Methods: In this controlled experimental study, twenty-four female Wistar Hannover rats were divided into four groups: Control, TRZ, HAF, and ORC. The control group received medication used for the surgical procedure only. 3% TRZ, cell-free HAF, and 1 cm2 ORC (interceed®) were laid on the tissue on the antimesenteric side of each uterine horn damaged with a 10-Watt bipolar cautery. Adhesions were scored 30 days after the first surgical procedure. Results: The extent, severity, degree, total adhesion, inflammation, and fibrosis scores of the control group were significantly higher than those of the TRZ and HAF groups (P<0.05 for each). There was no significant difference between the Control and ORC groups in terms of inflammation (P=0.055), but all other parameters were significantly higher in the control group compared to the ORC group (P<0.05). The TRZ group had lower total adhesion scores (P=0.019) and histopathological scores (P=0.015, P=0.001) than the ORC group. Conclusions: TRZ and HAF may be useful in preventing pelvic adhesions.

Оценка эффективности комплексного подхода к профилактике послеоперационного спаечного процесса в малом тазу

Aim: to assess the efficacy of complex prevention of postoperative pelvic adhesions. Patients and Methods: this open-label comparative prospective study involved 222 women of reproductive age with gynecological diseases, tuboperitoneal infertility, and pelvic adhesions stage 1–2 diagnosed laparoscopically (according to the R-AFS classification). In the study group (n=112), the prevention of postoperative adhesions was performed using the authors’ algorithm that included separation of adhesions using HARMONIC ultrasonic energy, intra-abdominal injection of anti-adhesive agent based on a natural polymer of carboxymethyl cellulose, and IM sodium deoxyribonucleate from post-op day 1 with a 24-hour interval for 10 days. In the comparison group (n=110), separation of adhesions was performed using bipolar energy, and standard preventive measures were applied. The rate and severity of postoperative adhesions (via second-look laparoscopy), the recovery of reproductive function (by the fact of intrauterine pregnancy), and the quality of life (using MOS SF-36 and WHQ questionnaires) were evaluated. The levels of CD20+, CD4+, CD8+, and CD56+ lymphocytes cells were measured preoperatively and on postoperative days 3 and 14. Follow-up was 12 months. Results: authors’ preventive algorithm activates immunoregulatory mechanisms of cellular humoral immunity, reduces the rate (by 4.5 times, p&lt;0.001) and severity of adhesions (p = 0.047), increases the rate of pregnancy by 1.6 times, and provides maximum physical and psychological quality of life. Conclusions: authors’ algorithm of the prevention of postoperative pelvic adhesions in women with gynecological diseases and tuboperitoneal infertility is characterized by reliable clinical efficacy as demonstrated by the improvement of both early and long-term surgical outcomes. KEYWORDS: postoperative pelvic adhesions, small pelvis, prevention, cellular humoral immunity, infertility, reproductive function, quality of life. FOR CITATION: Sulima A.N., Puchkina G.A. Efficacy of complex preventive approach to postoperative pelvic adhesions. Russian Journal of Woman and Child Health. 2021;4(2):130–136. DOI: 10.32364/2618-8430-2021-4-2-130-136.

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.

Molsidomine (MOL) reducespostoperative pelvic adhesion: A rat uterine horn model

Aim: Postoperative pelvic adhesions (PPAs) are a common complication that leads to many problems. This study aimed to compare the role of Seprafilm (a protective barrier), and molsidomine (MOL), recognized for its antioxidative and antiproliferative effects, in preventing pelvic adhesion. Material and Methods: A total of 30 of female Wistar albino rats were randomly divided into 3 groups. They underwent bilateral uterine horn injury. The rats in the Sham group (n=10) received no special treatment. The rats in the Seprafilm group (n=10) were treated withSeprafilm. The rats in the MOL group (n=10) received 10 mg/kg MOL orally for 14 days. Adhesion scores were evaluated using macroscopic, microscopic, and immunohistochemical grading 14 days postoperatively. Results:The Majuzi adhesion score of the rats in the MOL group [1 (0-4)] was lower than the score of the rats in the sham [4 (2-5)] and Seprafilm [4 (1-5)] (p

Effects of quercetin and surgicel for preventing adhesions after gynecological surgery: A rat uterine horn model.

Postoperative pelvic adhesions are significant health care problems causing chronic pelvic pain, infertility and intestinal obstruction after abdominal or pelvic surgery. We investigated the effects of quercetin and Surgicel for the prevention of adhesions after gynecological surgery. A double blind, randomized, controlled experimental study was designed. Forty female Wistar Hannover rats were divided into five groups: control, sham operated, quercetin, Surgicel, and quercetin + Surgicel. The control group received medication used for the surgical procedure only. The sham group received a laparotomy only. The quercetin group received 15 mg/kg quercetin in addition to undergoing the standard surgical procedure, and the injuries in the surgical group were covered with a single, 1 cm2 layer of Surgicel (oxidized regenerated cellulose). The quercetin + Surgicel group received both 15 mg/kg quercetin and a single, 1 cm2 layer of Surgicel. Adhesions were scored 14 days after the first surgical procedure. The extent, severity, degree, total adhesion, inflammation and fibrosis scores of the control group were significantly higher than those of the quercetin, Surgicel, and quercetin + Surgicel groups. There was no significant difference between the Surgicel and quercetin groups in degree, but all other parameters were significantly higher in the Surgicel than in the quercetin group. The quercetin + Surgicel group had lower adhesion scores than the quercetin group. Quercetin, Surgicel and quercetin + Surgicel treatment may be useful for preventing pelvic adhesions.

Tranexamic acid and hyaluronate/carboxymethylcellulose create cell injury.

Background and Objectives:Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention effects of tranexamic acid (TA) and hyaluronate/carboxymethylcellulose (HA/CMC) barrier in the rat uterine horn models on the basis of macroscopic and microscopic adhesion scores and histopathological as well as biochemical parameters of inflammation.Methods:Twenty-one Wistar rats were randomly divided into 3 groups. Ten lesions were created on the antimesenteric surface of both uterine horns by bipolar cautery. Three milliliters of 0.9% sodium chloride solution were administered in the control group. A single layer of 2 × 2 cm HA/CMC was plated in group 2. Two milliliters of TA was applied in the last group. All rats were sacrificed at postoperative day 21.Results:No significant difference was found among the control group, the HA/CMC group, and the TA group in terms of macro-adhesion score (P = .206) and microadhesion score (P = .056). No significant difference was found among the 3 groups in terms of inflammation score (P = .815) and inflammatory cell activity (P = .835). Malondialdehyde levels were significantly lower in the control group than in the TA group and HA/CMC group (P = .028). Superoxide dismutase and glutathione S-transferase activities were found to be higher in the control group than in the TA group (P = .005) and HA/CMC group (P = .009).Conclusions:TA and HA/CMC had no efficacy in preventing macroscopic or microscopic adhesion formation and decreasing inflammatory cell activity or inflammation score in our rat models. TA and HA/CMC increased the levels of free radicals and reduced the activities of superoxide dismutase and glutathione S-transferase enzymes, which act to reduce tissue injury.

Lipoic acid decreases peritoneal adhesion formation in a rat uterine scar model

To investigate the effects of lipoic acid in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemistry in a rat uterine horn model with full thickness injury. Twenty-eight female Wistar albino rats were randomised into four groups: uterine trauma control, 15 days and 30 days, and uterine trauma + lipoic acid, 15 days and 30 days. A full thickness defect was established by incising a segment of approximately 1.0 cm in length from each uterine horn, leaving the mesometrium intact. Extension and severity of the adhesions in each group were scored by a visual scoring system and evaluated immunohistochemically. Adhesion scores were 2.00±0.81, 2.14±0.69 0.71±0.75, and 0.85±0.69 for extent and 2.28±0.48, 2.14±0.69, 0.85±0.69, and 1.14±0.69 for severity in Groups 1, 2, 3 and 4, respectively. Adhesion extent and severity were significantly less for groups treated by lipoic acid but no difference was observed between long and short administration. Both Vitronectin and u-PAR staining were significantly increased in treatment groups when compared to the control group. Lipoic acid was found to be effective in reducing postoperative adhesion formation in a rat model.

Feasibility of high-intensity–focused ultrasound (HIFU) for treatment of polycystic ovarian syndrome: potential for noninvasive treatment

Purpose Polycystic ovarian syndrome (PCOS) affects 5-10 % of females in the child bearing period and is a common cause of infertility in this population. Surgical treatment is indicated for patients resistant to medical management. We investigate the feasibility of using HIFU as a non-invasive treatment of PCOS. Materials and Methods Ex-vivo canine ovaries fixed in gelatin were held in degassed water in front of an integrated 3.5 MHz dual mode ultrasound array (DMUA) system fenestrated to allow simultaneous use of a diagnostic transducer. DMUAs are transducers capable of imaging and treating with HIFU simultaneously using the same elements. Synthetic aperture (SA) and single transmit focus (STF) imaging were used to guide the treatment and HIFU shots (about 9-11 kW/cm 2 , 2 sec exposure time) were done at 6-7 mm depth. Ovaries were then sectioned and photographed to inspect the resultant damage. Results Echogenic changes were observed on imaging at the focal spot. Localized damage (~8×5 mm) was detected at the cortico-medullary interface; corresponding to the site of the echogenic changes. The ovarian surface was smooth and intact. SA imaging clearly showed the anatomical details of the ovaries. Conclusion We report the first use of DMUAs for potential treatment of PCOS by HIFU. Results demonstrate the feasibility of inducing thermal damage in ovaries without significant damage to the ovarian surface. This could potentially reduce the incidence of post-operative pelvic adhesions. Further, it should be possible to apply HIFU through a transvaginal probe, thus eliminating the risk associated with laparoscopy. SA imaging provided high resolution imaging that can guide the treatment. Further research is still needed to refine the exposure parameters and provide histological characterization of the HIFU induced damage.

Effect of sunitinib on functional reproductive outcome in a rabbit model

To determine the effect of sunitinib (Sutent; SU11248; Pfizer), a US Food and Drug Administration-approved receptor tyrosine kinase inhibitor previously shown to reduce de novo pelvic adhesion formation, on reproductive function after surgical uterine abrasion in a rabbit model. Randomized placebo-controlled study. Large animal facility within an academic hospital. Thirty New Zealand White adult female rabbits (2.2-3.0 kg). Administration of 11 doses (one preoperative and 10 postoperative) of oral sunitinib (10 mg/kg/d) or placebo. Effect of short-term postoperative sunitinib administration on reproductive function after surgical uterine abrasion. All animals were impregnated and survived until designated euthanasia. Sunitinib-treated animals had a larger average litter size (7.7 ± 1.9 vs. 5.6 ± 2.7 kits) and offspring viability (7.1 ± 2.7 vs. 3.5 ± 3.2 kits) compared with placebo-treated animals. There was no difference in gestational length or aberration in the maintenance of fertility. There were no gross abnormalities, detectable birth defects, or growth disparity in offspring from sunitinib versus placebo-treated mothers. The adhesion burden identified at euthanasia after parturition was lower in sunitinib compared with placebo-treated animals (N = 10/group). Sunitinib ameliorated adhesion-induced reproductive aberrations after surgical uterine abrasion and may be an efficacious strategy to reduce postoperative pelvic adhesions.

Creation of an animal model for post-operative adhesion prevention

To establish a rabbit double uterine horn model for assessing the time-course of pelvic adhesions and evaluating the effectiveness of different anti-adhesive materials in reducing adhesions. A total of 330 Japanese white rabbits underwent laparotomy, followed by uterine horn incision. Animals were euthanized after 3, 7, 14, 28, and 42 days, respectively. The surgical procedure was smooth. Rabbit double uterine horn model was applied for the evaluation of pelvic adhesions in a three-dimension fashion. Each of the three means-gauze abrasion, needle holder clamping, and direct uterine incision induced postoperative pelvic adhesions, among which direct uterine incision was the best to mimic conditions after gynecological operations. Under normal circumstances, degradation of filmy fibrinous adhesions by locally released proteases of the fibrinolytic system occurred within 3 days of injury. The regeneration of the mesothelium was completed within 7 days. Collagen reached its peak by day 14. Anti-adhesive materials were supposed to be completely absorbed by day 28, and their effectiveness in preventing pelvic adhesions was confirmed at this time point. Whether their effect can be maintained after the absorption of the anti-adhesive materials was investigated in 42 days. The animal model was successfully established. It well mimics the postoperative pelvic adhesions after direct uterine horn injury and thus is a suitable model for studying site-specific adhesions. Observations on the 3rd, 7th, 14th, 28th, and 42nd post-operative days provided a full picture of the adhesion formation process.

Evaluation of the effects of gonadotropin-relasing hormone antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative adhesion formation in a rat model with immunohistochemical analysis

To investigate the effects of GnRH antagonist (GnRH-ant) and agonist (GnRH-a) in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemical methods in a rat uterine horn model. Controlled experimental animal study. Animal laboratory at an academic research environment. Twenty-one Wistar albino rats. Rats were randomized into three groups. One week before the operation the rats received either GnRH-ant or GnRH-a or saline solution; they then underwent surgical laparotomy, and both uterine horns were traumatized by a scalpel. Three weeks later, all rats were sacrificed and extension and severity of the adhesions in each group were scored by a visual scoring system. Adhesion tissues were evaluated immunohistochemically for vitronectin and u-PAR. Scores of extend and severity of adhesions and staining of vitronectin and u-PAR. The extent of adhesion scores were 1.85 ± 0.86, 0.78 ± 1.05, and 0.42 ± 0.64, and the severity of adhesion scores were 1.71 ± 0.91, 0.57 ± 0.85, 0.50 ± 0.75 for control, GnRH-ant, and GnRH-a groups, respectively. The extent and severity of adhesions were significantly lower in both GnRH-ant and GnRH-a groups when compared with the control group. Adhesion extent scores in the GnRH-a group were lower than in the GnRH-ant group, but this difference was not significant. vitronectin and u-PAR staining were significantly greater in both the GnRH-ant and GnRH-a groups than in the control group. GnRH-ant as well as GnRH-a reduced postoperative adhesion formation in a rat model. This finding was supported immunohistochemically by vitronectin and u-PAR staining.

Single-Versus Double-Layer Hysterotomy Closure at Primary Caesarean Delivery and Bladder Adhesions

The risk of postoperative pelvic and abdominal adhesions is increased among women with repeat cesarean delivery. Several studies have addressed the role of single- versus double-layer uterine incision closure at the time of cesarean delivery to reduce maternal and neonatal morbidity. This retrospective study was a secondary analysis of the data in the previous prospective cohort trial that evaluated the effect of parietal peritoneal closure on the development of adhesion formation in women undergoing a first repeat cesarean. The aim of this investigation was to determine whether single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary cesarean delivery were associated with subsequent adhesion formation at the time of repeat cesarean delivery. Patient records of 127 pregnant women from the primary caesarean delivery were reviewed to identify whether single- or double-layer hysterotomy closure had been performed. The main study outcome measure was the frequency of pelvic and abdominal adhesions. Multivariable logistic regression analysis was used to control for potential confounders. At the time of primary cesarean section, 56 (44%) of the 127 women had single-layer hysterotomy closure and 71 (56%) had double-layer closure. The single-layer procedure was associated with significantly more bladder adhesions at the time of repeat cesarean compared with the double-layer technique (24% versus 7%, P = 0.01). After adjustment for potential confounding factors, the odds of bladder adhesions were 7 times greater with single-layer hysterotomy closure (odds ratio, 6.96; 95% confidence interval, 1.72–28.1). No differences were found between the 2 procedures in the frequency of adhesions at other surgical sites. These findings show that bladder adhesions occurred more frequently during repeat cesarean deliveries with primary single-layer hysterotomy closure than with the double-layer technique.

A Method for the Consistent Creation and Quantitative Testing of Postoperative Pelvic Adhesions in a Porcine Model

Introduction: The assessment of methods for the prevention of postoperative pelvic adhesions is hampered by the lack of a quantifiable adhesion measurement technique. Currently available methods for adhesion model assessment rely on qualitative grading scales; a quantitative method would have many attendant benefits, including standardized reporting. Methods: A technique was developed to generate consistent and significant adhesions in a swine model that are suitable for quantitative assessment using a Material Testing System (MTS) machine platform. In this method, the uterine horns are cannulated and then attached to the pelvic sidewall using loose silk sutures. The underlying sidewall and adjacent uterine serosa are injured with electrocautery. Following a two-week survival the entire complex of uterine horn and sidewall are excised en bloc and prepared for MTS testing. Results: Extrication of the adhesion, as measured by the MTS platform, generates a quantitative assessment of adhesion strength that can be scaled and analyzed to produce several continuous variable descriptions. Discussion: This technique represents a novel quantitative method for adhesion assessment in an animal model. This quantitative technique may then be applied to accurately assess a range of adhesion prevention techniques, producing results which can be standardized for comparison.

Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy

Background: Colonoscopy can be difficult in some women who have undergone hysterectomy, which can be associated with a fixed, angulated sigmoid colon caused by postoperative pelvic adhesions. Our goal was to determine whether colonoscopy is easier and more comfortable for women after hysterectomy when performed with a pediatric colonoscope, which is thinner in diameter and more flexible than a standard “adult” colonoscope. Methods: One hundred women with a history of hysterectomy undergoing outpatient colonoscopy were randomized in unblinded fashion to colonoscopy with a standard colonoscope (CF-100L or CF-Q140L, Olympus) or with a pediatric colonoscope (PCF-100, Olympus). All procedures were performed by a faculty endoscopist and timed. After examination, the endoscopist graded procedure difficulty, and patients were given a questionnaire that assessed their experience. Results: The cecum was intubated more frequently in the pediatric colonoscope group than in the standard colonoscope group (96.1% vs. 71.4%, p < 0.001). Success increased in the standard colonoscope group to 89.8% when the pediatric colonoscope was used to complete the examination. There were no differences in the two groups in terms of mean total procedure times (21.4 minutes vs. 22.6 minutes), mean doses of meperidine administered (57 mg both groups), mean doses of midazolam administered (1.5 mg vs. 1.7 mg), scales of procedure difficulty as graded by the endoscopists, and comfort scales as graded by patients. For the cases in which the cecum was intubated, the mean time to reach the cecum (11.7 minutes for the pediatric colonoscope group vs. 12.7 minutes for the adult) was similar. Conclusions: The pediatric colonoscope is a reasonable choice for colonoscopy in women who have had a hysterectomy. Alternatively, if the endoscopist elects to start the procedure with a standard colonoscope, it is helpful to have a pediatric colonoscope available for use should a fixed, angulated sigmoid colon be encountered that cannot be easily or safely traversed with the standard colonoscope. (Gastrointest Endosc 2002;55:838-41.)

Comprehensive preventive health care in female-factor infertility: issues, problems and proposals

Presently available information on the causation and management of infertility disorders is sufficient for the formulation of some tentative proposals for the provision of preventive reproductive health care to females. This should be aimed at preventing the initiation of the infertility-associated disorder in the first place (primary prevention), at detecting and preventing overt manifestations of disease (secondary prevention) and/or halting or slowing disease progression, and at reducing long-term morbidity and preventing mortality (tertiary prevention). This review will suggest ways to implement such preventive strategies with respect to the care of women with endometriosis, polycystic ovary syndrome, tubal pathology, and hypoestrogenism. We will also discuss the prevention of iatrogenic problems encountered during infertility management such as multiple pregnancy, ovarian hyperstimulation syndrome, postoperative pelvic adhesions, and delayed referral for subspecialist care. These primary care issues should be considered by all physicians who care for females from infancy, through adolescence, to the reproductive and postreproductive age periods. We hope that dialogue and future developments will lead to further refinement of our present proposals.

Serosal and Endometrial Reconstitution During Myomectomy

Context : Myomectomy is usually performed when uterine fibroids are associated with infertility. Serosal and endometrial reconstitution are some of the subtle challenges that the gynaecologist has to deal with during myomectomy, in an attempt to minimise postoperative pelvic and intrauterine adhesions. Objective : This study was conducted to evaluate the effect of careful apposition of the serosa and endometrium on subsequent development of post-myomectomy pelvic and intrauterine adhesions and to assess the effect of resection of redundant endometrium on subsequent menorrhagia. Study Design, Setting, and Subjects : A review of 17 patients with previous myomectomy who eventually had a subsequent laparotomy for various indications between June 1992, and July 1998 in the University College Hospital, Ibadan was carried out. Main Outcome Measures : Operative findings at myomectomy, as well as therapeutic procedures performed on them were recorded. Patients' observation of changes in menstrual blood loss postoperatively was also recorded. The presence of pelvic adhesions at re-laparotomy and intrauterine adhesions on hysterosalpingography in those who had endometrial reconstitution was also noted. Results : Continuous closure was found to be beneficial in all cases of serosal defects. Excision of redundant endometrium in 11 women was associated with subjective reduction of menorrhagia in 9 of them. Conclusion : It is advisable that gynaecological surgeons strive to minimise areas of visceral trauma, ischaemia and abrasion during myomectomy. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 16-18)

Altered expressions of VEGF mRNA splice variants during progression of uterine-peritoneal adhesions in the rat.

Postoperative pelvic adhesions contribute to infertility, pelvic pain, bowel obstruction, and difficult reoperative procedures. In the present study, a rat uterine-peritoneal adhesion model was developed to study the progression of adhesion formation during a course of 7 days following pelvic surgery. The distal 1 cm of each uterine horn and its adjacent peritoneum was abraded by six scratches with a scalpel blade, producing punctate bleeding. The scratched portion of uterine horn and the peritoneum was then held with Vicryl 3-0 to promote adhesion. The uterine tissue and the portion of peritoneum, held with suture, were then excised from a group of four rats, each at 6, 12, 24, 48, 72 hr and 5 and 7 days following surgery. Total RNA was isolated from these tissues and the expression pattern of different splice variants of vascular endothelial growth factors (VEGF) was examined using relative abundance reverse transcriptase polymerase chain reaction (RA-RT-PCR) method. Three known splice variants of VEGF mRNA (VEGF120, VEGF164 and VEGF188), as well as an additional band (approximately 510 bp), were amplified from these tissues. The relative abundance of known VEGF isoforms demonstrated altered expression during adhesion progression. When compared with noninjured uterine tissues, VEGF120 and VEGF188 demonstrated up-regulation during early stages of adhesion formation, whereas VEGF164 rather demonstrated down-regulation 24 and 48 hr following surgery. The up-regulation of VEGF isoforms during the progression of uterine-peritoneal adhesion may be a compensatory mechanism regulating angiogenesis in order to provide nutrients and oxygen to the injured tissues.

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.

Effectiveness comparison of products to prevent postoperative pelvic adhesions

Effectiveness comparison of products to prevent postoperative pelvic adhesions