Adhesion-prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look laparoscopy: a prospective, randomized, controlled study.
OBJECTIVE
To examine the adhesion prevention effects of 2 types of fibrin sealant after laparoscopic myomectomy (LM).


METHODS
A prospective, randomized study (Canadian Task Force I) was conducted at a University-affiliated hospital. A total of 91 patients showing a minimal myoma > 5 cm, excluding pedunculated myomas, underwent LM alone: 32 patients in the control group, 29 in the fibrin gel group and 30 patients in the fibrin sheet group. After LM, postoperative adhesions were evaluated by second-look laparoscopy. The frequency of postoperative adhesions was the main outcome.


RESULTS
The frequency of postoperative adhesions of the uterus was significantly lower (p < 0.05) in the fibrin gel group, with 20/32 (62.5%) in the control group, 10/29 (34.5%) in the fibrin gel group and 20/30 (67.7%) in the fibrin sheet group. Although no significant differences were found in the incidence of de novo adnexal adhesions, the lowest rate was found in the fibrin gel group, with 4/32 patients (12.5%) in the control group, 2/29 patients (6.8%) in the fibrin gel group and 5/30 patients (16.7%) in the fibrin sheet group. No bilateral adnexal adhesions were observed in the 3 groups.


CONCLUSIONS
After LM for myomas as large as > or = 5 cm, postoperative adhesions were observed in > or = 50% of patients. The use of fibrin gel after LM is recommended.
Takeuchi
Hiroyuki
H
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. hirotake@med.juntendo.ac.jp
Kitade
Mari
M
Kikuchi
Iwaho
I
Shimanuki
Hiroto
H
Kumakiri
Jun
J
Kinoshita
Katsuyuki
K
D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005782:Gels; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D009215:Myometrium / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D024162:Second-Look Surgery / Q000379:methods; D000267:Tissue Adhesions / Q000453:epidemiology / Q000517:prevention & control; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000453:epidemiology / Q000517:prevention & control*; D014594:Uterine Neoplasms / Q000601:surgery*
D015718:Fibrin Tissue Adhesive; D005782:Gels; D014014:Tissue Adhesives