Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy?
OBJECTIVE
To evaluate the chance of adhesion formation after laparoscopic salpingo-ovariolysis and determine the efficacy of early second-look laparoscopy (SLL).


METHODS
Prospective, randomized study (Canadian Task Force classification I).


METHODS
Shiraz University hospitals.


METHODS
Ninety women with mean duration of infertility of 7.2 years.


METHODS
Operative laparoscopy, with early SLL with adhesiolysis in 46 (group 1) and no SLL in 44 women (group 2).


RESULTS
Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification. Separation of newly reformed adhesions was performed at the time of SLL. Patients were followed for a year after operation without other infertility treatment. At the time of operation in group 1, adnexal adhesions were graded as severe (class D) in 19 women, moderate (class C) in 31, mild (class B) in 28, and minimal (class A) in 14. Respective figures in group 2 were 10, 30, 34, and 14. After salpingo-ovariolysis these figures were 12, 10, 20, and 50 in group 1 and 6, 14, 17, and 51 in group 2. In group 1 in whom early second-look laparoscopy was performed, at the start of the operation these figures were 17, 20, 21, and 34, and after operation 12, 8, 20, and 52, respectively. There were 11 term pregnancies in group 1 and 15 in group 2. No women with severe adhesions in either group conceived. In group 1, chances of term pregnancy were 18.75% for those with moderate adhesions, 35.71% for women with mild adhesions, and 42.86% in patients with minimal adhesions. Respective figures in group 2 were 26.67%, 41.18%, and 57.14%.


CONCLUSIONS
The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2%. Although separation of these adhesions could be performed more easily at the time of early SLL, the chance of pregnancy did not increase compared with that in patients who did not undergo SLL.
Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Iran.
Saeed
S
Alborzi
Shahdokht
S
Motazedian
Mohammad E
ME
Parsanezhad
D000328:Adult; D005184:Fallopian Tube Diseases / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010053:Ovary / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012489:Salpingostomy / Q000009:adverse effects / Q000379:methods*; D024162:Second-Look Surgery; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome