Pelvic Adhesions: Laparoscopic Approach
A retrospective study using the American Fertility Society's Adhesion Scoring Method and the MCASM (More Comprehensive Adhesion Scoring Method) and a prospective, randomized, controlled, multicenter trial (Canadian Task Force Classification I) were conducted. Of 2124 cases operated by laparoscopy, 465 patients had adhesions. Fifty-one female patients underwent open or laparoscopic myomectomy procedures with vs. without application of SprayGel adhesion barrier prevention, followed by second-look laparoscopy to evaluate postoperative adhesions. Details of the 465 cases of adhesiolysis are given. In subgroup 1 (n= 34) there were no preexisting adhesions. All 34 patients were assessed at a second-look laparoscopy for adhesion occurrence after 68 weeks; 29.4% were found to have no adhesions and 70.6% of patients had significant or mild adhesions. In subgroup 2, 21 patients who had undergone previous surgery for adhesiolysis were operated upon again, and 24% revealed an increased adhesion score, 57% the same adhesion score, and 19% a reduced adhesion score at second-look laparoscopy. Out of 51 patients enrolled, 45 were randomized to either treatment (n= 24) or control (n= 21). Three to sixteen weeks following surgery, 18 of 24 treatment patients (75%) and 13 of 21 controls (61.9%) had second-look laparoscopies (SLL). SLL showed 5 of 18 treatment patients (27.8%) were adhesion free vs. 1 in 13 of controls (7.7%). Patients randomized to SprayGel treatment were 3.6 times more likely to be adhesion free than patients randomized to control. Compared to the initial surgery, the severity score showed a 22% reduction in the treated group vs. a 39% increase in the control group, and a 12% reduction of adhesion area in the treated group vs. a 37% increase in the control group at SLL. New data confirmed previous knowledge
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