Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy.
OBJECTIVE
To determine the incidence, site, and grade of ovarian adhesion formation after laparoscopic ovarian drilling (LOD) and analyze the association between the number of punctures made and the incidence and grade of adhesions, and evaluate the lateral distribution of the adhesions.


METHODS
Prospective clinical study.


METHODS
University hospital endocrine and infertility center.


METHODS
Ninety-six anovulatory infertile women with polycystic ovarian syndrome (PCOS) treated with LOD.


METHODS
Women were randomized into two study groups of 48 women each, one treated with 6 punctures on the left ovary and 12 on the right, and the other treated with 6 punctures on the right ovary and 12 on the left. A short-term second-look minilaparoscopy was performed to evaluate postsurgical adhesion formation.


METHODS
[1] Evaluation of the incidence and grade (thin, dense, cohesive) of ovarian adhesions; [2] comparative analysis of the incidence and grade of ovarian adhesions between ovaries treated with 6 and 12 punctures; and [3] comparative analysis of the incidence and grade of ovarian adhesions between the two sides.


RESULTS
Adhesion formation was detected in 54 of the 90 women (60%) and in 83 of the 180 ovaries treated (46%). Dense adhesions were more likely to develop on the left ovaries to a statistically significant extent, and independently of the number of ovarian punctures performed (odds ratio [OR] = 4.34, 95% confidence interval [CI] = 1.72-10.94). Logistic regression analysis showed that the incidence of ovarian adhesions was independent of both number of punctures (OR = 1.05, 95% CI = 0.58-1.88) and side (OR = 1.37, 95% CI = 0.76-2.46).


CONCLUSIONS
The incidence of ovarian adhesion formation after LOD was high, and their extent and severity was not influenced by the number of ovarian punctures; however, the left ovary appeared more prone to develop severe adhesions than the contralateral one.
Mercorio
Francesco
F
Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy. Electronic address: fmercorio@libero.it.
Mercorio
Antonio
A
Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy.
Di Spiezio Sardo
Attilio
A
Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
Vincenzo Barba
Gian
G
Epidemiology of Population Genetics, Institute of Food Science, C.N.R. Avellino, Italy.
Pellicano
Massimiliano
M
Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
Nappi
Carmine
C
Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
D000328:Adult; D000858:Anovulation / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D016015:Logistic Models; D010049:Ovarian Diseases / Q000209:etiology* / Q000473:pathology; D010053:Ovary / Q000601:surgery*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology