Laparoscopic adhesiolysis for infertile patients with pelvic adhesive disease

Abstract

Thirty patients with secondary infertility were subjected to laparoscopic adhesiolysis during the period January 1986 to February 1987 at Al-Azhar Endoscopy and Microsurgery Unit. Second look laparoscopy (SLL) was performed after a period of 9-12 months. At laparoscopy, pelvic adhesive disease was staged according to the severity of the disease and compared with the finding at SLL. Five patients defaulted, three patients (12%) became pregnant and 22 patients underwent SLL. Ten patients (45.5%) showed no recurrence of adhesions. This study suggests that laparoscopy has a role in adhesiolysis of mild and moderate adhesions and SLL provides further opportunity to relyse reformed adhesions in some cases.

Laparoscopic management of recurrent adhesive small-bowel obstruction: Long-term follow-up

“…4 Traditionally, laparotomy and adhesiolysis was the treatment of choice when conservative measures failed or when clinical and physiologic derangements suggested toxemia and/or ischemia. Recent promising reports indicate the feasibility and potential superiority of this minimally invasive approach to the adhesionencased abdomen, such as in the setting of chronic abdominal or pelvic pain, 5−7 infertility, 8,9 small-bowel incarceration caused by a broad ligament defect, 10 and acute and chronic SBO. 11−17 We report our experience of performing successful laparoscopic adhesiolysis in 46 patients with recurrent SBO caused by postoperative intra-abdominal adhesions.…”

A first-in-human, randomized, controlled, subject- and reviewer-blinded multicenter study of Actamax™ Adhesion Barrier

“…Lysis of adhesions at an early stage in their formation is easier as they are more likely to be filmy and avascular, and it appears more successful than if undertaken later [ 23 – 25 ]. This may improve clinical outcomes, improve fertility [ 21 , 26 – 28 ] and reduce other adhesion-related complications including the long-term risk of SBO and future re-operative complications. In women with endometriosis treated during surgery, a second-look procedure allows evaluation and treatment of any early recurrence as part of a protocol maximizing both cure rate and pregnancy outcomes [ 29 ].…”

“…Undertaking an SLL enables close evaluation of safety within the abdominopelvic cavity and provides the opportunity for assessment of the potential therapeutic value of the investigational device to be used in planning future studies [ 33 ]. From the patient’s perspective, the SLL serves as a valuable tool for their surgeon to formulate a likely prognosis on natural conception or need for assisted reproduction, as well as to lyse adhesions and treat recurring pathology at an early stage following the initial surgery [ 21 , 22 , 26 , 28 , 29 ].…”

Abdominal adhesions: intestinal obstruction, pain, and infertility

“…Some gynecologists advocate an early second look after 1 week to prevent the transformation of fibrinous attachments into permanent adhesions [2,12,54,83,86,88]. Others postpone second-look laparoscopy for 3-12 months because if pregnancy occurs during this time, secondary surgery is obviously unnecessary to establish the presence of adhesions and to perform lysis [79].…”