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Esber S, Etrusco A, Laganà AS, Chiantera V, Arsalan HM, Khazzaka A, Dellino M, Sleiman Z. Clinical Outcomes after the Use of Antiadhesive Agents in Laparoscopic Reproductive Surgery. Gynecol Obstet Invest 2023; 88:325-335. [PMID: 37757758 PMCID: PMC10794970 DOI: 10.1159/000534170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Intra-abdominal adhesions are abnormal fibrous attachments between tissues and organs that can be congenital or acquired. Adhesion formation is a critical postoperative complication that may lead to bowel obstruction, chronic abdominal pain, and infertility. Physical barrier agents separate opposing peritoneal surfaces in the critical 5-day period of remesotheliazation. These agents are subdivided into solid or liquid/gel. Liquid agents seem easier to use in laparoscopic procedures than solid agents. METHODS The search for suitable articles published in English was carried out using the following databases: MEDLINE, Embase, Global Health, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database, Web of Science, and search register (ClinicalTrial.gov). Only studies reporting data about the impact of the use of an antiadhesive agent on adhesion formation after a primary gynecologic laparoscopic surgery were considered eligible. RESULTS Twenty-two papers that met the inclusion criteria were included in this systematic review. CONCLUSIONS Surgeons should consider applying antiadhesive agents after gynecologic surgery to help reduce adhesion formation and its adverse effects. However, further studies are still needed to confirm their impact on reproductive outcome and to implement clear guidelines on their per-operative application.
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Affiliation(s)
- Sabine Esber
- Department of Obstetrics and Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy,
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | | | - Aline Khazzaka
- Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Ensan B, Bathaei P, Nassiri M, Khazaei M, Hassanian SM, Abdollahi A, Ghorbani HR, Aliakbarian M, Ferns GA, Avan A. The Therapeutic Potential of Targeting Key Signaling Pathways as a Novel Approach to Ameliorating Post-Surgical Adhesions. Curr Pharm Des 2022; 28:3592-3617. [PMID: 35466868 DOI: 10.2174/1381612828666220422090238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Peritoneal adhesions (PA) are a common complication of abdominal operations. A growing body of evidence shows that inhibition of inflammation and fibrosis at sites of peritoneal damaging could prevent the development of intra-abdominal adhesions. METHODS A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords 'postsurgical adhesion', 'post-operative adhesion', 'peritoneal adhesion', 'surgery-induced adhesion' and 'abdominal adhesion'. Studies detailing the use of pharmacological and non-pharmacological agents for peritoneal adhesion prevention were identified, and their bibliographies were thoroughly reviewed to identify further related articles. RESULTS Several signaling pathways, such as tumor necrosis factor-alpha, tissue plasminogen activator, and type 1 plasminogen activator inhibitor, macrophages, fibroblasts, and mesothelial cells play a key part in the development of plasminogen activator. Several therapeutic approaches based on anti-PA drug barriers and traditional herbal medicines have been developed to prevent and treat adhesion formation. In recent years, the most promising method to prevent PA is treatment using biomaterial-based barriers. CONCLUSION In this review, we provide an overview of the pathophysiology of adhesion formation and various agents targeting different pathways, including chemical agents, herbal agents, physical barriers, and clinical trials concerning this matter.
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Affiliation(s)
- Behzad Ensan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parsa Bathaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Nassiri
- Recombinant Proteins Research Group, The Research Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Majid Khazaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Ghorbani
- Orology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Obrzut B, Obrzut M. Is There Still a Place for Reconstructive Surgery in Distal Tubal Disease? J Clin Med 2022; 11:jcm11123278. [PMID: 35743348 PMCID: PMC9225341 DOI: 10.3390/jcm11123278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Tubal diseases account for 25–40% of female factor infertility. Mainly, they involve the distal part of the fallopian tube, and hydrosalpinx is the most severe manifestation. Usually, the management decision is made between reconstructive surgery and ART, depending on the severity of the tubal damage, patient age, ovarian reserve, and seminogram, as well as financial, religious, ethical, and psychological factors. Estimated live-birth rates after corrective surgery range from 9% to 69%. The success rate of IVF is about 30% live-birth rate per cycle initiated in women across all ages with tubal factor infertility. Surgery offers a long-term cure and patients may attempt conception many times but are burdened with perioperative adverse events. IVF bypasses potential complications of operative treatment; however, this has its own unique risks. The effectiveness of reconstructive surgery versus ART has not been adequately evaluated. The success of fertility management depends on a thorough interpretation of existing data and careful patient selection. The presented review provides updates on the most recent progress in this area.
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Affiliation(s)
- Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rejtana 16 C, 35-959 Rzeszow, Poland
- Correspondence:
| | - Marzanna Obrzut
- Center for Diagnostic Medical Sonography, Litewska 4/4, 35-302 Rzeszow, Poland;
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Wang J, Peng C, Chen Z, Sun S, Shi Z, Jin L, Zhao W, Zhao C. Engineering antimicrobial and biocompatible electrospun PLGA fibrous membranes by irradiation grafting polyvinylpyrrolidone and periodate. Colloids Surf B Biointerfaces 2019; 181:918-26. [DOI: 10.1016/j.colsurfb.2019.06.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/16/2019] [Accepted: 06/25/2019] [Indexed: 12/24/2022]
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Penzias A, Bendikson K, Falcone T, Gitlin S, Gracia C, Hansen K, Hill M, Hurd W, Jindal S, Kalra S, Mersereau J, Odem R, Racowsky C, Rebar R, Reindollar R, Rosen M, Sandlow J, Schlegel P, Steiner A, Stovall D, Tanrikut C. Postoperative adhesions in gynecologic surgery: a committee opinion. Fertil Steril 2019; 112:458-463. [DOI: 10.1016/j.fertnstert.2019.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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Biondo-Simões MDLP, Oda MH, Pasqual S, Robes RR. Comparative study of polyglactin 910 and simple catgut in the formation of intraperitoneal adhesions. Acta Cir Bras 2018. [DOI: 10.1590/s0102-865020180020000001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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Bolnick A, Bolnick J, Diamond MP. Postoperative Adhesions as a Consequence of Pelvic Surgery. J Minim Invasive Gynecol 2015; 22:549-63. [DOI: 10.1016/j.jmig.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
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Kwon YJ, Hyung EJ, Yang KH, Lee HO. How different modes of child delivery influence abdominal muscle activities in the active straight leg raise. J Phys Ther Sci 2014; 26:1271-4. [PMID: 25202194 PMCID: PMC4155233 DOI: 10.1589/jpts.26.1271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the activities of the abdominal muscles of women who had experienced vaginal delivery in comparison with those who had experienced Cesarean childbirth. [Subjects and Methods] A total of 14 subjects (7 vaginal delivery, 7 Cesarean section) performed an active straight leg raise to 20 cm above the ground, and we measured the activities of the internal oblique abdominal muscle, the external oblique abdominal muscle, and the rectus abdominal muscle on both sides using electromyography. The effort required to raise the leg was scored on a Likert scale. Then, the subjects conducted maximum isometric contraction for hip joint flexion with the leg raised at 20 cm, and maximum torque and abdominal muscle activities were measured using electromyography. [Results] During the active straight leg raise, abdominal muscle activities were higher in the Cesarean section subjects. The Likert scale did not show a significant difference. The activities of the abdominal muscles and the maximum torque of the hip joint flexion at maximum isometric contraction were higher in the vaginal delivery subjects. [Conclusion] The abdominal muscles of Cesarean section subjects showed greater recruitment for maintaining pelvic stability during the active straight leg raising, but were relatively weaker when powerful force was required. Therefore, we consider that more abdominal muscle training is necessary for maintaining pelvic stability of Cesarean section subjects.
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Affiliation(s)
- Yu-Jeong Kwon
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Eun-Ju Hyung
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
| | - Kyung-Hye Yang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
| | - Hyun-Ok Lee
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Toyganözü H, Nazik H, Narin R, Satar D, Narin MA, Büyüknacar S, Api M, Aytan H. Examination of the ovarian reserve after generation of unilateral rudimentary uterine horns in rats. ScientificWorldJournal 2014; 2014:918496. [PMID: 24672393 DOI: 10.1155/2014/918496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 11/21/2022] Open
Abstract
Objective. The purpose of this experimental rat model study is to evaluate the changes in the ovarian environment after excision of the rudimentary horn. Methods. Ten female Wistar albino rats were used in this study. One cm of right uterine horn length was excised in the first operation. Two months after the first operation, all animals were sacrificed to obtain ovaries for histological examination. Mann-Whitney U test and Student's t-test were used for statistical analysis purposes. Statistical significance was defined as P < 0.005. Results. The number of primordial follicles (P = 0.415), primary follicles (P = 0.959), preantral follicles (P = 0.645), antral follicles (P = 0.328), and Graafian follicles (P = 0.721) was decreased and the number of atretic follicles (P = 0.374) increased in the right ovarian side. Howeve,r this difference was not found to be statistically significant. Conclusion. The results of this experimental rat model study suggest that the excision of rudimentary horn could have negative effects on ipsilateral ovarian functions.
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Abstract
L'infertilité d'origine tubo-péritonéale est toujours d'actualité, sa fréquence reste stable, sinon croissante. La coelioscopie permet à la fois d'affirmer l'atteinte tubaire et de proposer un geste thérapeutique adapté. Le but de notre travail est d’évaluer les résultats de la chirurgie laparoscopique des pathologies tubaires en termes de grossesses obtenues. Il s'agit d'une étude rétrospective descriptive, analytique et longitudinale. Nous avons colligé les patientes suivies pour infertilité et opérées pour pathologies tubaires distales au service A du centre de maternité et de néonatologie de Tunis. Nous avons étudié les caractéristiques épidémiologiques et cliniques des patientes, les résultats de l'imagerie et détaillé les gestes chirurgicaux réalisés. Les résultats de la chirurgie tubaire distale étaient exprimés en termes de grossesses obtenues avec un recul minimal de 12 mois et maximal de 5 ans. 898 patientes étaient prises en charge dans le service pour une infertilité dont 52 patientes avaient répondu aux critères d'inclusion à l’étude. La sensibilité de l'hystérosalpingographie en matière de lésions tubaire était de 69% et la spécificité de 100%. Selon le score d'opérabilité tubaire distale, 23% des lésions étaient classées au stade 4 et 13.46% au stade 1. Le taux de grossesses spontanées était de 8.69%, soit 13% des fimbrioplasties et 4% des néosalpingostomie. Le délai de conception allait de 4 à 9 mois. Les antécédents ou stigmates d'infection pelvienne étaient retenus comme facteur de mauvais pronostic. Une sélection rigoureuse des patientes à partir des données de l'hystérographie et de la coelioscopie est indispensable afin de déterminer les patientes candidates à une chirurgie réparatrice ou à une fécondation in vitro
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Affiliation(s)
- Kaouther Dimassi
- Faculté de Médecine, Université de Tunis EL MANAR, Tunis, Tunisie
| | - Anissa Gharsa
- Service de Gynécologie-Obstétrique A, Centre de Maternité, Tunis, Tunisie
| | - Mohamed Badis Chanoufi
- Faculté de Médecine, Université de Tunis EL MANAR, Tunis, Tunisie ; Service de Gynécologie-Obstétrique A, Centre de Maternité, Tunis, Tunisie
| | - Ezzeddine Sfar
- Faculté de Médecine, Université de Tunis EL MANAR, Tunis, Tunisie ; Service de Gynécologie-Obstétrique A, Centre de Maternité, Tunis, Tunisie
| | - Dalenda Chelli
- Faculté de Médecine, Université de Tunis EL MANAR, Tunis, Tunisie ; Service de Gynécologie-Obstétrique A, Centre de Maternité, Tunis, Tunisie
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Abstract
The main female anatomical causes of infertility include post-infectious tubal damage, endometriosis, and congenital/acquired uterine anomalies. Congenital (septate uterus) and acquired (myomas and synechiae) diseases of the uterus may lead to infertility, pregnancy loss, and other obstetric complications. Pelvic inflammatory disease represents the most common cause of tubal damage. Surgery still remains an important option for tubal factor infertility, with results in terms of reproductive outcome that compare favorably with those of in vitro fertilization. Endometriosis is a common gynecologic condition affecting women of reproductive age, which can cause pain and infertility. The cause of infertility associated with endometriosis remains elusive, suggesting a multifactorial mechanism involving immunologic, genetic, and environmental factors. Despite the high prevalence of endometriosis, the exact mechanisms of its pathogenesis are unknown. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. In the majority of cases, surgical treatment of endometriosis has promoted significant increases in fertilization rates. There are obvious associations between endometriosis and the immune system, and future strategies to treat endometriosis might be based on immunologic concepts.
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Affiliation(s)
- Mauricio S Abrao
- Department of Obstetrics and Gynecology, Sao Paulo University, Sao Paulo, Brazil
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Rajab TK, Kimonis KO, Ali E, Offodile AC, Brady M, Bleday R. Practical implications of postoperative adhesions for preoperative consent and operative technique. Int J Surg 2013; 11:753-6. [PMID: 23962663 DOI: 10.1016/j.ijsu.2013.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/02/2013] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
Abstract
Adhesions complicate most intra-peritoneal operations. Once adhesions have formed, patients are at life-long risk for complications that include small bowel obstruction, increased risks during subsequent operations and female infertility. This has two implications for the daily work of surgeons. On the one hand, surgeons need to include the risks from adhesions during pre-operative consent. On the other hand, surgeons need to use operative techniques that minimize adhesions. Therefore this review focuses on the practical implications of adhesions for preoperative consent and operative technique.
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Affiliation(s)
- Taufiek Konrad Rajab
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril 2013; 99:1550-5. [PMID: 23472951 DOI: 10.1016/j.fertnstert.2013.02.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 12/12/2022]
Abstract
Postoperative adhesions are a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Adherence to microsurgical principles and minimally invasive surgery may help to decrease postoperative adhesions. Some surgical barriers have been demonstrated effective for reducing postoperative adhesions, but there is no substantial evidence that their use improves fertility, decreases pain, or reduces the incidence of postoperative bowel obstruction. This document replaces the document of the same name last published in 2008 (Fertil Steril 2008;90[5 Suppl]:S144-9).
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Abstract
The introduction of in-vitro fertilisation within reproductive medicine has prompted questions to be asked about the relevance of reproductive surgery. Reproductive surgery is more than a competing discipline; it is complementary to the techniques of in-vitro fertilisation. As a complementary discipline, reproductive surgery covers the field of tubal and ovarian pathology and correction of uterine alterations. In recent decades, more attention has been paid to the importance of the uterus in the process of conception and implantation. The place of reproductive surgery and the existing controversies in the treatment of uterine congenital and acquired pathology, tubal, and ovarian surgery are discussed. Continuous training and accreditation programmes for reproductive technologies and surgery are more important than ever.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium.
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ten Broek R, Kok- Krant N, Bakkum E, Bleichrodt R, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Hum Reprod Update 2012; 19:12-25. [DOI: 10.1093/humupd/dms032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Fallon EM, Nehra D, Le HD, Nedder AP, Guo L, Mitchell PD, Rueda BR, Puder M. Effect of sunitinib on functional reproductive outcome in a rabbit model. Fertil Steril 2012; 98:496-502. [DOI: 10.1016/j.fertnstert.2012.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/28/2012] [Accepted: 05/11/2012] [Indexed: 11/17/2022]
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Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 2011; 17:4545-53. [PMID: 22147959 PMCID: PMC3225091 DOI: 10.3748/wjg.v17.i41.4545] [Citation(s) in RCA: 272] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/26/2011] [Accepted: 09/03/2011] [Indexed: 02/06/2023] Open
Abstract
Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.
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Chanelles O, Ducarme G, Sifer C, Hugues JN, Touboul C, Poncelet C. Hydrosalpinx and infertility: what about conservative surgical management? Eur J Obstet Gynecol Reprod Biol 2011; 159:122-6. [DOI: 10.1016/j.ejogrb.2011.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 06/10/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
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Schnüriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D. Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg 2011; 201:111-21. [PMID: 20817145 DOI: 10.1016/j.amjsurg.2010.02.008] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND postoperative adhesions are a significant health problem with major implications on quality of life and health care expenses. The purpose of this review was to investigate the efficacy of preventative techniques and adhesion barriers and identify those patients who are most likely to benefit from these strategies. METHODS the National Library of Medicine, Medline, Embase, and Cochrane databases were used to identify articles related to postoperative adhesions. RESULTS ileal pouch-anal anastomosis, open colectomy, and open gynecologic procedures are associated with the highest risk of adhesive small-bowel obstruction (class I evidence). Based on expert opinion (class III evidence) intraoperative preventative principles, such as meticulous hemostasis, avoiding excessive tissue dissection and ischemia, and reducing remaining surgical material have been published. Laparoscopic techniques, with the exception of appendicitis, result in fewer adhesions than open techniques (class I evidence). Available bioabsorbable barriers, such as hyaluronic acid/carboxymethylcellulose and icodextrin 4% solution, have been shown to reduce adhesions (class I evidence). CONCLUSIONS postoperative adhesions are a significant health problem with major implications on quality of life and health care. General intraoperative preventative techniques, laparoscopic techniques, and the use of bioabsorbable mechanical barriers in the appropriate cases reduce the incidence and severity of peritoneal adhesions.
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Affiliation(s)
- Beat Schnüriger
- Los Angeles County Medical Center, University of Southern California, Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery and Surgical Critical Care, LAC + USC Medical Center, Room 1105, 1200 North State St, Los Angeles, CA, USA
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Abstract
The process of informed consent is a critical aspect of the doctor-patient relationship. Doctors have a professional duty to provide patients with sufficient information if a treatment is associated with a significant risk. NHS guidelines advise doctors to mention risks that occur more frequently than 1-2% or risks that are serious even if the likelihood is very small. In the case of abdominal and pelvic surgery, risks can broadly be divided into early and late complications. Early complications, such as bleeding and infection, have a close temporal relationship with the operation. Such complications are routinely mentioned during the consent process. In contrast, postoperative adhesions cause changes in the normal anatomy that can adversely affect function many years and even decades after the original operation, leaving patients at lifelong risk for late complications. These late adhesive complications, namely bowel obstruction, mechanical female infertility and chronic pain, are often neglected during the consent process. However, the risks to patients from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by a number of claims against the NHS based on consent issues regarding late adhesive complications of surgery. Therefore, late complications of surgery from adhesions should be included in the pre-operative consent process. This would decrease litigation costs but more importantly also underpins the doctor-patient relationship.
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Affiliation(s)
- Taufiek Konrad Rajab
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School 75 Francis Street, Boston, MA 02115, USA.
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Kraemer B, Birch JC, Birch JV, Petri N, Ahmad U, Marikar D, Wallwiener M, Wallwiener C, Foran A, Rajab TK. Patients’ awareness of postoperative adhesions: results from a multi-centre study and online survey. Arch Gynecol Obstet 2010; 283:1069-73. [DOI: 10.1007/s00404-010-1504-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
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Botolin S, Agudelo J, Dwyer A, Patel V, Burger E. High rectal injury during trans-1 axial lumbar interbody fusion L5-S1 fixation: a case report. Spine (Phila Pa 1976) 2010; 35:E144-8. [PMID: 20110832 DOI: 10.1097/BRS.0b013e3181ca7351] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report. OBJECTIVE To report a case of high rectal injury during trans-1 axial Lumbar Interbody Fusion (axiaLIF) L5-S1 fixation. SUMMARY OF BACKGROUND DATA Trans-1 axiaLIF procedure is gaining in popularity for L5-S1 fusion due to the ease of access to the sacrum through the presacral space. Normally, the midline of the sacrum at S1-S2 is relatively free from neurovascular and intra-abdominal structures, making this level a safe entry point for the axiaLIF procedure. We report a case of high rectal injury during Trans-1 axiaLIF L5-S1 procedure due to altered intra-abdominal anatomy as a result of multifactorial adhesions formation. METHODS A 44-year-old female patient with a history of previous anterior and posterior spinal surgeries, pelvic inflammatory disease, and non-disclosed previous diverticulitis, developed a high rectal injury during Trans-1 axiaLIF L5-S1 fixation. RESULTS After Trans-1 axiaLIF L5-S1, the patient presented with an episode of melena and hypogastric pain with nausea and vomiting. A computed tomography (CT) scan of the abdomen with intravenous and oral contrast showed presacral soft tissue fluid density with fat stranding and extraluminal rectal contrast and gas with some areas of soft tissue enhancement compatible with probable high rectal perforation. Patient's symptoms gradually subsided during a period of 6 months with aid from a temporary diverting ileostomy and a course of i.v. antibiotics. No spine implants were removed. CONCLUSION We report a case of high rectal injury during Trans-1 axiaLIF L5-S1 fixation and strongly advice that patients who are candidates for this surgery and have any risk factors for intra-abdominal adhesion formation, undergo a pelvic CT with rectal contrast before the surgery to evaluate for any signs of altered rectal-sacral anatomy.
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Nilsson E, Björn C, Sjöstrand V, Lindgren K, Münnich M, Mattsby-Baltzer I, Ivarsson ML, Olmarker K, Mahlapuu M. A novel polypeptide derived from human lactoferrin in sodium hyaluronate prevents postsurgical adhesion formation in the rat. Ann Surg 2009; 250:1021-8. [PMID: 19953722 DOI: 10.1097/sla.0b013e3181b246a7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate whether a peptide derived from human lactoferrin, PXL01 could act safely to reduce the formation of peritoneal adhesions in the rat model and to map the molecular mechanisms of its action. SUMMARY BACKGROUND DATA Adhesion formation is a significant problem within every surgical discipline causing suffering for the patients and major cost for the society. For many decades, attempts have been made to reduce postsurgical adhesions by reducing surgical trauma. It is now believed that major improvements in adhesion prevention will only be reached by developing dedicated antiscarring products, which are administrated in connection to the surgical intervention. METHODS Anti-inflammatory as well as fibrinolytic activities of PXL01 were studied in relevant human cell lines. Using the sidewall defect-cecum abrasion model in the rat, the adhesion prevention properties of PXL01 formulated in sodium hyaluronate were evaluated. Large bowel anastomosis healing model in the rat was applied to study if PXL01 would have any negative effects on intestine healing. RESULTS PXL01 exhibits an inhibitory effect on the most important hallmarks of scar formation by reducing infections, prohibiting inflammation, and promoting fibrinolysis. PXL01 formulated in sodium hyaluronate markedly reduced formation of peritoneal adhesions in rat without any adverse effects on wound healing. CONCLUSIONS A new class of synthetically derived water soluble low molecular weight peptide compound, PXL01 showed marked reduction of peritoneal adhesion formation in an animal model without any negative effects on healing. On the basis of these data, a comprehensive adhesion prevention regimen in clinical situation is expected.
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Rajab TK, Wallwiener M, Talukdar S, Kraemer B. Adhesion-related complications are common, but rarely discussed in preoperative consent: a multicenter study. World J Surg 2009; 33:748-50. [PMID: 19194740 DOI: 10.1007/s00268-008-9917-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Peritoneal adhesions are recognized as an important cause for patient morbidity, but complications related to adhesions occur relatively late after the original operation. Therefore preoperative consent may not adequately reflect the proportions of the problem. METHODS A total of 200 patients admitted for intraperitoneal operations at six hospitals were prospectively reviewed to identify whether adhesion-related complications were documented as possible adverse events in their respective consent forms. RESULTS Adhesion-related complications were documented in 8.5% (n=17) of consent forms (bowel obstruction n=8, requirement for further operations n=5, difficult reoperation n=1, pain n=3). A direct relationship with adhesions was noted in n=9 of these consent forms. CONCLUSIONS Preoperative informed consent does not adequately reflect the magnitude of adhesion-related problems. These findings have immediate implications for clinical practice.
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Affiliation(s)
- Taufiek Konrad Rajab
- Department of Surgery, Central Middlesex Hospital, Imperial College London, London, NW10 7NS, UK.
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Abstract
Tubal factors are estimated to account for 15–20 per cent of infertility. The incidence not only depends on the patient population but is probably also underestimated since evaluation of tubai function is largely restricted to the appraisal of its patency. Consequently the treatment of tubai infertility is primarily focused on the restoration of tubai patency. That infertility frequently persists in spite of successfully restored patency and that tubal pregnancy frequently occurs after infertility surgery suggest that underlying disease has not been diagnosed.
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Reyftmann L, Dechanet C, Amar-Hoffet A, Flandrin A, Hédon B, Dechaud H. [Surgery for infertility]. J Gynecol Obstet Biol Reprod (Paris) 2009; 38 Spec No 1-2:F35-F42. [PMID: 19268223 DOI: 10.1016/s0368-2315(09)70230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- L Reyftmann
- Service de gynécologie obstétrique et département de médecine et biologie de la reproduction, CHU A.-de-Villeneuve, Montpellier.
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Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril 2008; 90:S144-9. [PMID: 19007613 DOI: 10.1016/j.fertnstert.2008.08.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/09/2007] [Accepted: 04/09/2007] [Indexed: 10/21/2022]
Abstract
Postoperative adhesions are a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Adherence to microsurgical principles, minimally invasive surgery, and use of some peritoneal instillates may help to decrease postoperative adhesions. Some surgical barriers have been demonstrated effective for reducing postoperative adhesions, but there is no substantial evidence that their use improves fertility, decreases pain, or reduces the incidence of postoperative bowel obstruction.
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Abstract
Important progress has been made in the field of post-surgical adhesion prevention with the development of consensus statements in gynaecology from the United Kingdom, Germany, the European Society of Gynaecological Endoscopy, Call for Action in Colorectal Surgery and a recent Technical Bulletin from The Practice Committee of the American Society of Reproductive Medicine. These reports suggest that the application of adhesion reduction devices together with the use of microsurgical principles reduces the formation of post-operative adhesions. This commentary provides additional information to assist gynaecologists in making surgical decisions. However, variation in adhesion classifications, mode of device application, lack of uniformity in surgical approaches and variations in interpretation of results make comparative assessment of the efficacy of adhesion reduction devices and surgical techniques difficult. Considering the choice of an adhesion-reduction device, one has to evaluate the cost and its clinical impact carefully. This is particularly important if one were to support routine, prophylactic use of adhesion-reduction devices. Healthcare providers should take into account the needs of individual patients, available resources, and institutional or clinical practice limitations. Good surgical technique and perhaps the use of approved devices for adhesion reduction would give patients the best chance to benefit from reproductive and gynaecological surgery.
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Affiliation(s)
- Gere S diZerega
- Department of Obstetrics and Gynecology, Livingston Reproductive Biology Laboratory, USC Keck School of Medicine, 1321 N Mission Road, Los Angeles, CA 90033, USA.
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Abstract
Aside from the normal 'ad integrum' peritoneal regeneration, the postoperative intraperitoneal adhesion formation process may be considered as the pathological part of peritoneal healing following any injury, particularly a surgical one. Despite a large body of clinical and experimental studies, its pathophysiology remains controversial. Moreover, a better understanding of the pathophysiological events and of the medical and surgical factors involved in the adhesion formation process is pivotal in any attempt to control this very frequent phenomenon and its serious consequences.
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Affiliation(s)
- J-J Duron
- Chirurgie Générale et Digestive, Hôpital de la Pitié Salpêtrière, 83 Boulevard de l'Hôpital, Paris, France.
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DeWilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0338-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril 2007; 88:21-6. [PMID: 17613300 DOI: 10.1016/j.fertnstert.2007.04.066] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/09/2007] [Accepted: 04/09/2007] [Indexed: 11/16/2022]
Abstract
Postoperative adhesions are a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Adherence to microsurgical principles, minimally invasive surgery, and use of some peritoneal instillates may help to decrease postoperative adhesions. Some surgical barriers have been demonstrated effective for reducing postoperative adhesions, but there is no substantial evidence that their use improves fertility, decreases pain, or reduces the incidence of postoperative bowel obstruction.
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Abstract
The investigation of the infertile couple by hysterosalpingography and laparoscopy is currently a highly debated issue. The purpose of this paper is to review whether transvaginal hydrolaparoscopy (THL), a new culdoscopic approach, in combination with minihysteroscopy and chromopertubation test can be offered as a complete one-stop endoscopic exploration. The technique allows complete endoscopic exploration of the reproductive tract in an office or outpatient setting and has been validated during the past years for its accuracy, safety and patient tolerance. Although further prospective randomized studies are required to prove the superiority and cost-benefit of transvaginal hydrolaparoscopy as diagnostic tool in comparison with hysterosalpingography (HSG) and laparoscopy, the technique can be proposed as a safe first-line investigation predicting the fertility outcome in women.
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Affiliation(s)
- Hugo C Verhoeven
- Center for Reproductive Medicine and Endocrinology, Duesseldorf, Germany.
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Ait Menguellet S, Collinet P, Cosson M, Mariette C, Triboulet JP, Vinatier D. Intérêt des produits antiadhérentiels en chirurgie gynécologique. ACTA ACUST UNITED AC 2007; 35:290-6. [PMID: 17337231 DOI: 10.1016/j.gyobfe.2007.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/05/2007] [Indexed: 01/17/2023]
Abstract
Adhesion barriers are intraperitoneal agents, solid or fluid, developed in order to prevent postoperative adhesions. In this article, we evaluate the efficiency of these new barrier agents for adhesion prevention in gynaecologic surgery, undertaking a review of controlled clinical trials published. Several human clinical trials demonstrated the safety and efficiency of both Interceed and Seprafilm. As far as other barrier agents are concerned, data are still insufficient to recommend them for clinical use. There is a need for other randomised controlled trials in order to evaluate functional efficiency of anti adhesion agents.
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Affiliation(s)
- S Ait Menguellet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire (CHRU) de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Practice Committee of the American Society for Reproductive Medicine. Control and prevention of peritoneal adhesions in gynecologic surgery. Fertil Steril 2006; 86:S1-5. [PMID: 17055798 DOI: 10.1016/j.fertnstert.2006.07.1483] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 09/05/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
Abstract
Postoperative adhesion formation is a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Microsurgical principles and minimally invasive surgery may help decrease adhesion formation, but anti-inflammatory agents and peritoneal instillates have no demonstrable benefit. Although some surgical barriers are effective for reducing postoperative adhesions, none has been shown to improve fertility or to decrease pain or the incidence of postoperative bowel obstruction.
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Abstract
Tubal disease is a major cause of infertility. The amount of damage can vary greatly in extent, anatomical location and nature. For women with infertility due to tubal disease, prognostication for pregnancy often remains unclear and there is no universally accepted classification. A classification system that reliably distinguishes infertile patients with tubal disease into favourable and unfavourable groups would be useful if subsequent management could depend on this assessment, especially if the classification is able to define which group of patients would benefit most from interventions such as surgery. The progress of IVF questions the contribution of the Fallopian tube to the successful achievement of pregnancy in infertile women. Nonetheless, several studies reveal that severity is the key factor in the determining outcome, and the classifications reviewed in this paper imply that women with tubal disease could be categorized into prognostic groups using a simple classification system based on severity. However, prospective trials are needed to validate and assert the usefulness of any particular classification.
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Affiliation(s)
- Valentine A Akande
- Fertility Clinic, Division of Women's Health, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
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Bayrak A, Harp D, Saadat P, Mor E, Paulson RJ. Recurrence of hydrosalpinges after cuff neosalpingostomy in a poor prognosis population. J Assist Reprod Genet 2006; 23:285-8. [PMID: 16865531 PMCID: PMC3506369 DOI: 10.1007/s10815-006-9050-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 05/01/2006] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the recurrence rate of hydrosalpinges after cuff neosalpingostomy in poor prognosis candidates. METHODS Forty consecutive patients with hydrosalpinx treated with cuff neosalpingostomy were included. Main outcome measures were recurrence rate of hydrosalpinx after cuff neosalpingostomy, intrauterine and ectopic pregnancy rates. RESULTS Intraoperatively, the mean size of the hydrosalpinx was 1.9+/-0.7 cm, and 77% of patients had evidence of pelvic adhesions. Recurrence of hydrosalpinx, whether unilateral or bilateral was 70% (28/40) per patient. Intrauterine and ectopic pregnancy rates were 5% (2/40) and 2.5% (1/40), with a total pregnancy rate of 7.5% (3/40). CONCLUSIONS Most patients experience recurrence of hydrosalpinx after cuff neosalpingostomy, thus requiring additional surgery such as salpingectomy prior to in vitro fertilization (IVF). In a poor prognosis population, salpingectomy should be considered as the primary treatment for hydrosalpinx prior to IVF.
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Affiliation(s)
- Aykut Bayrak
- Department of Obstetrics and Gynecology, University of Southern California-Keck School of Medicine, Women's and Children's Hospital, Los Angeles, CA 90033, USA.
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Suzuki T, Shibahara H, Hirano Y, Fujiwara H, Takamizawa S, Suzuki M. Feasibility and clinical significance of endoluminal assessment by transvaginal salpingoscopy during transvaginal hydrolaparoscopy in infertile women. J Minim Invasive Gynecol 2005; 12:420-5. [PMID: 16213428 DOI: 10.1016/j.jmig.2005.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 04/05/2005] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To investigate the feasibility and clinical usefulness of transvaginal salpingoscopy (TS) during transvaginal hydrolaparoscopy (THL) in infertile women. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING Jichi Medical School, Tochigi, Japan. PATIENTS One hundred thirty infertile women, aged 22 to 43 years, who underwent THL. INTERVENTIONS Transvaginal salpingoscopy findings in comparison with THL findings. MEASUREMENTS AND MAIN RESULTS Transvaginal salpingoscopy could be performed in 41.0% of the attempted tubes. In comparing rates of successful TS in relation to tubal patency, tubal morphology, and past Chlamydia trachomatis infection, patent tubes and normal-appearing tubes classified with normal morphology had a significantly higher TS success rate. However, past C. trachomatis infection did not affect the success of TS. There was a significant correlation between salpingoscopic and laparoscopic findings; however, there were no significant correlations between salpingoscopic findings and C. trachomatis antibody titers. CONCLUSIONS These findings suggest that TS can be performed simultaneously in some infertile women undergoing THL especially those with patent tubes or with normal-appearing tubes. Further studies are required to show the usefulness of intratubal exploration in assessing tubal infertility.
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Affiliation(s)
- Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Tochigi, Japan
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Diamond MP, Leach RE, Ginsburg KA, El-Mowafi DM, Dawe E, Scanlan RM. Effects of cornual catheterization on uterotubal histology and function. Fertil Steril 2005; 84:212-6. [PMID: 16009179 DOI: 10.1016/j.fertnstert.2004.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Revised: 12/15/2004] [Accepted: 12/15/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess histologic damage and functional impairment following coaxial tubal catheterization. DESIGN Prospective randomized controlled study. SETTING Research laboratory. PATIENT(S) Ninety-two female New Zealand rabbits. INTERVENTION(S) Tubal cannulation and mating. MAIN OUTCOME MEASURE(S) Rabbits randomized for placement of unilateral catheter and guide wire (group 1), unilateral catheter and guide wire plus falloposcope (group 2), and catheterization as in group 1 or 2 but using a cage catheter (groups 3 and 4, respectively). A fifth group consisted of rabbits with tubal perforations. Rabbits were killed at 2 or 4 weeks after catheterization or after mating. The sixth group consisted of only control rabbits. RESULT(S) Only one catheterized tube in groups 1 and 3 showed inflammation, fibrosis, or edema. None of the tubes manifested ciliary loss. Serosal tubal adhesions were identified in two tubes in group 1, in one in group 3, in three tubes in group 5, and one in the control group. The nidation index in control and nonperforated catheterized tubes ranged from 72%-95% (not significant). Nidation index in tubes unintentionally perforated was 81%. CONCLUSION(S) Catheterization of the uterotubal junction and fallopian tube in rabbits does not cause long-term tubal damage or impair tubal function.
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Affiliation(s)
- Michael P Diamond
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA.
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Abstract
OBJECTIVE This study explores the predictive value for live birth following tubal reconstructive surgery of the "Hull & Rutherford" (H&R) classification system. DESIGN Retrospective cohort study. SETTING Tertiary infertility referral service, University of Bristol. POPULATION Infertile women younger than 40 years with tubal damage undergoing tubal surgery. METHODS Women (n= 192) were grouped according to three severity grades of disease based on the H&R classification. Essentially, the main features of grade I tubal damage were filmy adhesions, whereas grades II and III referred to unilateral severe damage and bilateral severe damage, respectively. Standard surgical techniques were employed. Pregnancy and live birth rates were calculated and compared using time-specific univariate Kaplan-Maier curves and multivariate Cox's regression analysis. MAIN OUTCOME MEASURES Pregnancy, ectopic and live birth within three years of surgery. RESULTS A significant trend towards higher ectopic pregnancy rates (P < 0.001) with increasing severity of tubal damage was noted, but not miscarriage rates. Univariate analysis revealed significant differences in the live birth rates of 69%, 48% and 9% for grades I, II and III, respectively. Multivariate analysis (controlling for age, duration of and primary infertility) confirmed these differences to be significant with risk ratios of 13.7 (95% CI: 4.49-41.9) and 6.54 (95% CI: 2.48-17.24) for grades I and II disease, respectively, compared with grade III disease, used as the reference. CONCLUSIONS The H&R classification is a simple classification system that is able to distinguish women into three distinct groups giving a favourable, fair and poor prognosis for live birth following tubal surgery.
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Dechaud H, Reyftmann L, Faidherbe J, Hamamah S, Hedon B. Evidence-based reproductive surgery: tubal infertility. ACTA ACUST UNITED AC 2004; 1266:96-106. [DOI: 10.1016/j.ics.2004.01.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
STUDY OBJECTIVE To assess the feasibility of routine salpingoscopy and microsalpingoscopy by the vaginal route during fertiloscopy. DESIGN Retrospective continuous series (Canadian Task Force classification II-2). SETTING Private reproductive center. PATIENTS Five hundred infertile women with no obvious pathology. INTERVENTIONS; Fertiloscopy with salpingoscopy followed by microsalpingoscopy. MEASUREMENTS AND MAIN RESULTS Salpingoscopy was possible in 85% of women. In those with no pathology, only 8.2% had abnormal salpingoscopy but 37% had abnormal microsalpingoscopy. CONCLUSION Fertiloscopy allows salpingoscopy and microsalpingoscopy to be performed in a reproducible and simple manner. Thus intratubal exploration should be integral to infertility assessment.
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Affiliation(s)
- A Watrelot
- Centre de Recherche et d'Etude de la Stérilité, Le Britannia, 20 Boulevard Eugene Deruelle, 69003 Lyon, France
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Milingos S, Liapi A, Elsheikh A, Kallipolitis G, Protopapas A, Loutradis D, Miaris S, Milingos D, Michalas S. Hydrosalpinx Treatment: Comparison Between Laparoscopy and Laparotomy. J Gynecol Surg 2002. [DOI: 10.1089/104240602760172873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Spiros Milingos
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Anthi Liapi
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Alexander Elsheikh
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - George Kallipolitis
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Athanasios Protopapas
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Dimitrios Loutradis
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Spiros Miaris
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Dimitrios Milingos
- Infertility Division, 1st Department of Obstetrics and Gynecology, University of Athens, Athens, Greece and Alexandra University Hospital, Athens, Greece
| | - Stelios Michalas
- Alexandra University Hospital, Athens, Greece and National University of Athens School of Medicine, Athens, Greece
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Abstract
Tubal pelvic damage is a common cause of infertility, and laparoscopy is the accepted gold standard for its diagnosis. However, laparoscopy is both costly and invasive. Chlamydia is now recognized as the most common cause of tubal pelvic damage. In contrast to laparoscopy, evidence of past chlamydial infection using serology is readily available, and the test is simple and quick to perform. As such, serology can be used as a screening test in infertile women. It is accepted that screening tests may have higher margins of error and may be less accurate than diagnostic tests. Screening is most valuable when detecting a disease for which the treatment is more effective when undertaken at the earliest opportunity. Because there are justified constraints to the indiscriminate use of laparoscopy, there is a need to minimize the number of patients who do not have disease (false positives) who are subjected to this diagnostic investigation. An appropriate Chlamydia antibody titre that would distinguish women at risk of tubal pelvic damage should be determined using diagnostic test analysis and clinical judgement. Identification by serology of women who are likely to have damage would enable these women to undergo a diagnostic test such as laparoscopy sooner, allowing treatment to be provided earlier. However, the severity of tubal pelvic damage varies, and the need to distinguish women with a favourable or unfavourable prognosis after treatment using a simple classification system is discussed.
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Affiliation(s)
- Valentine Akande
- Division of Obstetrics and Gynaecology, University of Bristol, St Michael's Hospital, Bristol BS2 8EG, UK
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46
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Marchino GL, Gigante V, Gennarelli G, Mazza O, Mencaglia L. Salpingoscopic and laparoscopic investigations in relation to fertility outcome. J Am Assoc Gynecol Laparosc 2001; 8:218-21. [PMID: 11342728 DOI: 10.1016/s1074-3804(05)60581-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To evaluate the correlation between salpingoscopic and laparoscopic findings and their relation to reproductive outcomes. DESIGN Prospective study (Canadian Task Force classification II-2). SETTING University-affiliated hospital. PATIENTS Ninety-one infertile women. INTERVENTION Salpingoscopy and laparoscopy. MEASUREMENTS AND MAIN RESULTS Salpingoscopic findings were expressed according to a widely used classification. Tubal morphology at laparoscopy was defined as regular (normal morphology), convoluted (any kind of distortion or adhesion), or hydrosalpinx. Laparoscopic and salpingoscopic findings did not correlate. Seventeen pregnancies occurred within 1 year from the procedures. According to life table analysis, the cumulative pregnancy rate was significantly higher in women with endotubal morphology showing minimal or no tubal damage, than in women with higher grades of endotubal damage. Conversely, tubal morphology at laparoscopy was not able to predict pregnancy outcome. CONCLUSION Laparoscopy alone might not be sufficient to predict tubal integrity. Performing salpingoscopy with laparoscopy could significantly increase accuracy in predicting short-term fertility outcome. Given its low complication rate and brief duration, salpingoscopy should have a primary role in management of infertility.
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Affiliation(s)
- G L Marchino
- Department of Gynecological and Obstetrical Sciences, S. Anna Hospital, University of Turin, Via Baiardi 43, Turin 10126, Italy
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Abstract
OBJECTIVE To determine pregnancy rates after laparoscopic salpingostomy in occlusive distal tubal disease. To evaluate the relative impact of various historical, physical, and operative factors on pregnancy outcome using a multivariate statistical analysis. DESIGN Prospective cohort. SETTING University-affiliated tertiary care infertility clinic. PATIENT(S) One hundred thirty-nine infertile women with occlusive distal tube disease. INTERVENTION(S) Laparoscopic salpingostomy. MAIN OUTCOME MEASURE(S) The occurrence of intrauterine (IUP) and ectopic pregnancy (EP). RESULT(S) The overall IUP and EP rates were 24.5% and 16.5%, respectively. Analysis of historical variables, assessed independently, demonstrated a significantly higher IUP rate with a positive history of gonorrhea and a significantly higher EP rate with a positive history of pelvic inflammatory disease, lack of history of intrauterine device (IUD) usage, or the performance of a bilateral procedure. The logistic regression model to predict intrauterine pregnancy had an overall predictive value of 77.5% and included the following significant variables: secondary infertility, positive history of gonorrhea, and the operative finding of moderate periadnexal adhesions. The logistic regression model to predict ectopic pregnancy had an overall predictive value of 89.0% and included the following significant variables: previous ectopic pregnancy, negative history of IUD use, positive history of PID, a bilateral procedure, and perihepatic adhesions. CONCLUSION(S) Operative laparoscopy may be effective for the correction of hydrosalpinges in selected patients. The probability of achieving an intrauterine or an ectopic pregnancy can be predicted based on combinations of significant variables.
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Affiliation(s)
- R C Taylor
- University of British Columbia, Vancouver, Canada
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Abstract
PURPOSE To identify radiographic signs of mucosal damage by comparing hysterosalpingography with salpingoscopy in a prospective study. MATERIALS AND METHODS Forty-one candidates for laparoscopy underwent hysterosalpingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radiolucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was categorized by means of inspection into five classes of fold pattern: classes I and II, normal; classes III-V, abnormal. Hysterosalpingographic and salpingoscopic results were compared by means of a two-by-two table and kappa statistics. RESULTS Seventy-four tubes were evaluated. At hysterosalpingography, 31 tubes were distally nonpatent. Of these, 26 showed a distal obstruction at salpingoscopy. None of the patent tubes at hysterosalpingography showed obstruction at salpingoscopy. The agreement between hysterosalpingography and salpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 0.73; P: <.001). The cobblestone pattern always corresponded to intraluminal adhesions at salpingoscopy. The absence of radiolucent bands corresponded to abnormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal patent tubes at hysterosalpingography showed intraluminal adhesions at salpingoscopy. CONCLUSION Results indicate that the cobblestone pattern is an effective radiographic sign of intraluminal adhesions in hydrosalpinges and suggest that intraluminal disease in patent tubes might not always be excluded on normal hysterosalpingograms.
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Affiliation(s)
- A L Valentini
- Department of Radiology , , Universita' Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy.
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Valentini AL, Muzii L, Marana R, Catalano GF, Summaria V, Felici F, Rossetti A, Destito C. Improvement of hysterosalpingographic accuracy in the diagnosis of peritubal adhesions. AJR Am J Roentgenol 2000; 175:1173-6. [PMID: 11000185 DOI: 10.2214/ajr.175.4.1751173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our purpose was to compare hysterosalpingography with laparoscopy in the diagnosis of peritubal adhesions and to verify whether a combination of radiographic signs improves hysterosalpingographic accuracy. SUBJECTS AND METHODS Thirty candidates for laparoscopy underwent hysterosalpingography before surgery. Two radiologists evaluated the presence or absence and types of radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different criteria for normality or abnormality: no sign means a normal result, one or more signs mean an abnormal result (first criterion); no sign or one sign means a normal result, two or more signs mean an abnormal result (second criterion). Interpretation discrepancies were resolved by consensus. Peritubal and periovarian adhesions were evaluated by a single operating surgeon during laparoscopy (recorded on S-VHS videotape) and by a different surgeon reviewing the videotape. The radiographic results obtained using the two criteria in radiologically patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic results by 2 x 2 tables and were statistically analyzed (kappa statistics). RESULTS The first criterion displayed poor diagnostic accuracy. The correlation with laparoscopy was not statistically significant in either radiologically patent or distally nonpatent tubes. The second criterion greatly improved the agreement with laparoscopy, but only in patent tubes (kappa = 0.7789; p<0.001). CONCLUSION Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be improved in patent tubes by taking into account more than one of the reported radiographic signs.
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Affiliation(s)
- A L Valentini
- Department of Radiology, Università Cattolica del Sacro Cuore di Roma, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
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Milingos SD, Kallipolitis GK, Loutradis DC, Liapi AG, Hassan EA, Mavrommatis CG, Miaris SG, Michalas SP. Laparoscopic treatment of hydrosalpinx: factors affecting pregnancy rate. J Am Assoc Gynecol Laparosc 2000; 7:355-61. [PMID: 10924630 DOI: 10.1016/s1074-3804(05)60479-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of laparoscopic surgery in a series of women with hydrosalpinx. DESIGN Prospective, observational study (Canadian Task Force classification II-2). Setting. University-affiliated hospital. PATIENTS Sixty-one women undergoing bilateral neosalpingostomy and restoration of tubal ovarian anatomy laparoscopically, and followed for 24 months. INTERVENTION Video-controlled operative laparoscopy using standard four-puncture technique. MEASUREMENTS AND MAIN RESULTS During 24-month follow-up, cumulative intrauterine pregnancy rates at 6-month intervals were 6.8%, 13.6%, 20.5%, and 20.5% for patients with only distal tubal obstruction and 12%, 23%, 29%, and 29% for those with mild degree of tubal disease and periadnexal adhesions. Miscarriage rate for intrauterine pregnancies was zero in both groups. CONCLUSION Operative laparoscopy seems to be an effective treatment for hydrosalpinx in terms of pregnancy outcome.
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Affiliation(s)
- S D Milingos
- First Department of Obstetrics and Gynecology, University of Athens, Alexandra Maternity Hospital, Athens, Greece
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