Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease

Kişnişçi H; Yarali H; Develioğlu O; Zeyneloğlu H; Aksu T; Gürgan T

doi:10.1016/s0015-0282(16)54737-2

Reproductive Surgery Ovarian Surgery

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease

Kişnişçi H, Yarali H, Develioğlu O, Zeyneloğlu H, Aksu T, Gürgan T

Published December 1991 Fertility and Sterility, 56(6), 1176-1178

DOI 10.1016/s0015-0282(16)54737-2 PMID 1835936

RRM Academy Synopsis

Adhesions formed in 14 of 17 women after laparoscopic PCOS surgery

A 1991 case series of 17 women with polycystic ovarian disease found that adhesions formed in about 8 out of 10 women after ovarian electrocautery or laser surgery. At a second look 3 to 4 weeks later, surgeons cut the adhesions apart in most affected women.

Key Findings

Second-look laparoscopy 3 to 4 weeks after surgery found adhesions in 6 of 7 women (85%) after electrocautery and 8 of 10 women (80%) after Nd:YAG laser photocoagulation.
Of the 14 women with adhesions, 6 had minimal and 6 had mild adhesions, and 2 had moderate adhesions. Severe adhesions occurred in neither group.
Surgeons lysed adhesions at the second-look laparoscopy in 12 of 14 women (85%).
Within 6 months, 4 of 7 women (57%) in the electrocautery group and 4 of 10 women (40%) in the laser group had conceived. All pregnancies were intrauterine.
Five of 7 women (71%) ovulated within 3 months after electrocautery. In the laser group, 7 of 10 women (70%) had ovulatory cycles after the procedure.

Interpretation

This case series followed 17 women with polycystic ovarian disease at Hacettepe University in Ankara. The paper's term is polycystic ovarian disease. PCOS has since been renamed PMOS (polyendocrine metabolic ovarian syndrome). Seven women had electrocautery. Ten had Nd:YAG laser surgery. Each woman had primary infertility. None had ovulated on first-line fertility drugs. The authors think the pregnancies may be linked to the restored pelvic anatomy seen at second-look surgery. The findings support a larger, randomized trial to test that link.

RRM Context

Restorative reproductive medicine includes adhesion prevention in its care of the pelvis and fertility. The authors note that wedge resection of the ovary fell out of favor because adhesions appear to lower the chance of conception. Their second look found adhesions after these less extensive laparoscopic procedures too. Looking for adhesions shows surgeons how well an operation protects the pelvis.

Our editorial summary of this paper, not the article's abstract.

Abstract

The incidence and fertility effects of postoperative adhesion formation after laparoscopic ovarian electrocautery or laser photocoagulation of polycystic ovaries has not been adequately analyzed. Short-interval second-look laparoscopy appears to be a useful method for addressing this issue. Employing short-interval second-look laparoscopy 3 to 4 weeks after the initial laparoscopic intervention, we were able to demonstrate adhesions in 6 of 7 patients (85%) treated with ovarian electrocautery and 8 of 10 patients (80%) submitted to laser therapy. The adhesions were amenable to laparoscopic lysis in 12 of 14 patients (85%). The subsequent conception rates within 6 months of second-look laparoscopy that were 57% and 40% in the electrocautery and the Nd:YAG laser groups, respectively, may in part be attributed to the restoration of normal pelvic anatomy during this procedure.

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Topics

Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation · PMOS / PCOS › Surgical Treatment › Ovarian Drilling

Timur Gürgan, Osman Develioğlu

T Gürgan, O Develioğlu

PMID 1835936 1835936 DOI 10.1016/s0015-0282(16)54737-2 10.1016/s0015-0282(16)54737-2 Kişnişçi et al. 1991, Kişnişçi 1991

Keywords

Adult, Electrocoagulation/adverse Effects, Female, Fertility, Humans, Laparoscopy, Laser Therapy/adverse Effects, Light Coagulation/adverse Effects, Ovarian Diseases/etiology, Ovulation, Polycystic Ovary Syndrome/surgery, Postoperative Period, Tissue Adhesions/etiology

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease

Adhesions formed in 14 of 17 women after laparoscopic PCOS surgery

Key Findings

Interpretation

RRM Context

Abstract

Read the guides

Topics

By this author

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Keywords