title: Influencing factors of adhesion development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by a second-look laparoscopy.
abstract: OBJECTIVE
  To examine the factors influencing the development of adhesions after laparoscopic myomectomy (LM) and the efficacy of adhesion-preventing agents.
  
  
  METHODS
  Prospective nonrandomized study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Three hundred seventy-two patients who underwent LM alone by the same surgeon between 2000 and 2005 were included for the analysis in this study.
  
  
  METHODS
  Video tape recording was performed during the second-look laparoscopy (SLL) to evaluate the postoperative uterine wound adhesions and adhesions around the uterine adnexa. Statistical workup was conducted using logistic regression analysis.
  
  
  METHODS
  Evaluation of adhesions at the uterine wound and of de novo adhesions of the uterine adnexa by SLL.
  
  
  RESULTS
  The SLL revealed uterine surgical wound adhesions in 141 patients (37.9%) and de novo adhesions of the uterine adnexa in 33 patients (8.9%). The results of analysis to determine the factors influencing the development of postoperative adhesions revealed that the diameter of the largest myoma, number of myomas, and type of adhesion-preventing agent used (except for fibrin sheath, which had no effect) influenced the incidence of postoperative adhesions at the surgical wound, but only the diameter of the largest myoma influenced the incidence of de novo adhesions of the uterine adnexa.
  
  
  CONCLUSIONS
  Development of surgical wound adhesions after LM can be prevented by the use of an appropriate adhesion-preventing agent.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: hirotake@med.juntendo.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shimanuki
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
mesh_terms: D000290:Adnexa Uteri / Q000473:pathology; D000328:Adult; D002483:Cellulose, Oxidized / Q000627:therapeutic use; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D016015:Logistic Models; D010049:Ovarian Diseases / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D011183:Postoperative Complications; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D014594:Uterine Neoplasms / Q000601:surgery*
chemical_list: D002483:Cellulose, Oxidized; D015718:Fibrin Tissue Adhesive; C060002:INTERCEED