Reproductive Surgery Adhesion Prevention
RRM Academy Synopsis
Dextran 70 reduced pelvic adhesions after infertility surgery
A 1983 randomized, double-blinded trial in 102 women having infertility surgery found that dextran 70 placed in the pelvis reduced adhesions at several pelvic sites on a second laparoscopy. Marked adhesion reduction occurred in about 5 out of 10 women given dextran 70. Saline controls reached about 3 out of 10.
Key Findings
- 102 women aged 18 to 35 completed the trial at nine centers: 55 received dextran 70 and 47 received saline during surgery for tubal disease, endometriosis, or adhesions.
- A marked reduction in adhesions followed the first operation in 26 of 51 women given dextran 70 and 12 of 40 given saline (P < 0.05).
- Women with severe adnexal adhesions had a mean score reduction of 8.5 ± 0.92 with dextran 70 (n = 14) and 4.38 ± 1.86 with saline (n = 13; P < 0.025).
- Second-look laparoscopy found adhesions more often in saline-treated women at the ovary (P < 0.05), cul-de-sac (P = 0.017), and pelvic side wall (P < 0.001).
- Both groups showed improved tubal patency (P < 0.05) without a significant difference between groups; fimbrial, omental, and small bowel differences were also not significant.
Interpretation
The 1983 randomized trial followed 102 women who completed the study, aged 18 to 35, with tubal disease, endometriosis, or pelvic adhesions. A physician unaware of the assigned treatment performed the second laparoscopy 8 to 12 weeks later in women who had not conceived. The benefit appeared with severe adhesions and at the ovary, cul-de-sac, and pelvic side wall. The authors report that the benefit stayed in the lowest part of the pelvis, with no reduction in the upper abdomen. Two women in the saline group had fevers lasting over 2 days, and one dextran-treated woman had transient labial swelling.
RRM Context
The authors call adhesion formation a leading cause of persistent infertility after reconstructive tubal surgery. Restorative reproductive medicine repairs pelvic anatomy and keeps the pelvis working. Protecting that repair from scar tissue serves the same goal. This 1983 trial is an early randomized test of an adhesion-prevention adjuvant.
Abstract
Infertile women of reproductive age requiring an operation for distal tubal disease, endometriosis, or pelvic adhesions were recruited from nine study centers. Prior to closing the peritoneal cavity, 250 ml of 32% dextran 70 (n = 55) or saline (n = 47) was instilled into the dependent portion of the pelvis; 8 to 12 weeks later, laparoscopy was performed on those patients not pregnant. Patients with severe adnexal adhesions at the initial laparotomy had a greater reduction in adhesions if they received 32% dextran 70. Further, patients with a marked reduction in adhesion formation following the initial laparotomy were found to occur more frequently in the 32% dextran 70-treated group (26 of 51 for 32% dextran 70 versus 12 of 40 for saline; P less than 0.05). During second-look laparoscopy, adhesions were found to occur more frequently in control patients than in 32% dextran 70-treated patients at the following anatomic sites: ovary (P less than 0.05); cul-de-sac (P = 0.017); pelvic side wall (P less than 0.001). Thus, in a prospective, randomized, blinded clinical trial, the intraperitoneal high-molecular-weight dextran was found to reduce postoperative adhesion formation effectively.
Read the guide
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Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared
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.
Topics
Keywords
Adnexal Diseases/prevention & Control/surgery, Adult, Clinical Trials As Topic, Dextrans/administration & Dosage, Double-Blind Method, Female, Humans, Infertility, Female/surgery, Injections, Intraperitoneal, Laparoscopy, Laparotomy/adverse Effects, Pelvic Inflammatory Disease/etiology, Postoperative Complications/prevention & Control, Probability, Tissue Adhesions/prevention & Control, Dextrans
