Naether, O. G., & Fischer, R. (1993). Adhesion formation after laparoscopic electrocoagulation of the ovarian surface in polycystic ovary patients. Fertility and Sterility, 60(1), 95-98. https://doi.org/10.1016/s0015-0282(16)56043-9
Naether OG, Fischer R. Adhesion formation after laparoscopic electrocoagulation of the ovarian surface in polycystic ovary patients. Fertil Steril. 1993;60(1):95-98. doi:10.1016/s0015-0282(16)56043-9
Naether, Olaf G. J., and Robert Fischer. "Adhesion formation after laparoscopic electrocoagulation of the ovarian surface in polycystic ovary patients." Fertility and Sterility, vol. 60, no. 1, 1993, pp. 95-98.
For EndNote, Zotero or Mendeley:
Open access
Free to read
No reuse license
Free to read at the publisher (reported by Unpaywall and OpenAlex, not verified by RRM Academy)
Institute for Hormone and Fertility Research, University of Hamburg, Germany.
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
Adhesions followed ovarian electrocautery for PCOS in 12 of 62 women
About 19 of 100 second-look exams found adhesions after ovarian electrocautery. This case series looked again at 62 women with polyendocrine metabolic ovarian syndrome (PMOS / PCOS). About 17 of 100 women rinsed with saline after surgery had minimal adhesions.
Key Findings
Of 199 women treated, 62 had a second look. Adhesions were found in 19.3% of these examinations (12 of 62). Twelve of 50 repeat laparoscopies showed de novo adnexal adhesions.
No adhesions were found in the 12 women examined at cesarean section (0%).
Of 30 women who had saline lavage and artificial ascites after surgery, 5 had adhesions (16.6%), all minimal and on one side. The reduction was not statistically significant (P = 0.575).
Adhesions were tubo-ovarian in 5 women (2 minimal, 2 mild, 1 moderate), ovary to pelvic wall in 5 (all minimal), and bowel to ovary in 2 (minimal).
Early second-look laparoscopy took place 2 to 14 days after surgery (mean, 3.7 days). At that early second look, separating the adhesions was easy and bloodless in all cases.
Interpretation
This case series followed 62 women with polyendocrine metabolic ovarian syndrome (PMOS / PCOS) after ovarian electrocautery, with a saline lavage subgroup. The women had infertility and no ovulation, or high androgen levels that medicine did not control. Surgery was a last resort after other treatments failed. The authors say bleeding from the ovarian capsule during electrocautery caused the adhesions. Older studies found adhesion rates of 42% to 100% after open ovarian wedge surgery, and 0% to 86% after laparoscopic methods. The authors note that more patients might show a clearer lavage benefit. The findings support larger studies of ways to prevent adhesions after ovarian surgery.
RRM Context
Restorative reproductive medicine aims to restore ovulation and protect the tubes and ovaries needed for conception. Surgery that aims to restore ovulation raises a second question: what the operation leaves behind in the pelvis. Second-look findings count that cost directly. The lavage subgroup reports a technique meant to limit it.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To evaluate the incidence and extent of periovarian adhesion formation subsequent to laparoscopic electrocoagulation of the ovarian surface in infertility patients with polycystic ovarian disease (PCOD).
Design
From a total of 199 PCOD patients treated with ovarian electrocautery, 50 cases of laparoscopy and 12 cesarean sections served as second-look investigation. A subgroup of 30 patients had abdominal lavage and artificial ascites after surgery; they underwent "early" second-look (2 to 14 days after laparoscopy).
Setting
All patients were referred to our fertility outpatient clinic affiliated with the university hospital.
Patients
Infertility patients with polycystic ovarian reaction to hormonal stimulation therapy underwent laparoscopic electrocoagulation of the ovarian surface.
Results
Adhesion formation was detected in 19.3%; the incidence reduced to 16.6% with the use of abdominal lavage. The adhesions found were obviously due to bleeding of the ovarian capsule caused by electrocautery. Adhesiolysis was easily possible during "early" second-look.
Conclusion
The incidence of de novo adhesion formation caused by laparoscopic electrocoagulation of the ovarian surface seems to be lower than after ovarian wedge resection; it can be reduced by abdominal lavage and artificial ascites.
How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.
PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.
00g30e956 