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

Abstract

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

Myomectomy in infertile women: More harm than good?

“…It is generally believed that adhesion formation occurs in the first 3 to 5 days following surgery. In fact, some authors recommend very early SLL (within 7 days) ( 61 ); others believe that the early fine fibrinous adhesions are a normal consequence of tissue repair, due to local release of breakdown mediators in the remodeling process, and will eventually disappear with time and therefore recommend SLL between the time of serosal healing (eight days) and when fibrotic adhesion can be considered permanent (21 days) ( 62 ).…”

Myomectomy for Infertility: Does it Do More Damage Than Good?

“…Most experts agree that the first three to five days after surgery are when adhesion development takes place. In fact, some authors advise very early re-look surgery (within 8 days) [61]; however, other authors advise re-look surgery within the start of serosal healing (eight days) and the point at which fibrotic adhesions can be deemed permanent (21 days) [62]. These authors contend that the very early fine fibrinous adhesions are typical complications of tissue repair caused by the local release of breakdown mediators during the remodeling process and will eventually fade away with time.…”