[Study on transvaginal hydrolaparoscopic pelvic adhesiolysis in the infertile women.].
OBJECTIVE
To investigate the safety and efficacy of transvaginal hydrolaparoscopic pelvic adhesiolysis (THLPA) treatment in the infertile women.


METHODS
From May 2007 to Sep. 2008, 30 infertile patients underwent THLPA. The dye-test, hysteroscopy, and dye-test using catheterization of tubal ostium by hysteroscopy were performed at the same time. Pelvic adhesions were scored according to the revised American Fertility Society classification of endometriosis (1985). The adhesions were graded as mild (score 1-9), moderate (10-19), and severe (>/= 20). Twenty-four cases were in mild adhesions, 5 moderate adhesions, and 1 severe adhesion. The duration of the operation and discharge, pelvic adhesions score, tubal patency, complications, and pregnancy rate were investigated.


RESULTS
(1) THPLA: the majority of pelvic adhesions in all patients were successfully performed adhesiolysis. Only a little filmy adhesions of proximal peritube of 7 tubes and proper ligament of 5 ovaries and cohesive adhesions of 4 ovaries did not underwent surgical lysis. (2) Tubal patency: 35 tubes were of proximal occlusion by dye-test, of which 21 (60%, 21/35) were unobstructed and 4 (11%, 4/35) were partly unobstructed after the dye-test using catheterization of the tubal ostium by hysteroscopy. (3) The duration of operation: the overall operative time were (32 +/- 6) minutes in mild adhesion, (52 +/- 6) minutes in moderate adhesion, and 83 minutes in severe adhesion. Of which the time of THLPA were (11 +/- 5) minutes in mild adhesion, (35 +/- 7) minutes in moderate adhesion, and 62 minutes in severe adhesion, respectively. (4) The duration of discharge: the postoperative discharge time was 120 - 175 minutes. No complications occurred. (5) The rate of pregnancy: in the (15.8 +/- 4.3) months' follow-up, the rate of pregnancy was 45% (13/29), which one patient lost follow-up.


CONCLUSIONS
THLPA is safe, efficacious and not being hospitalized management. When compared with laparoscopy, it is simpler, more economic, and less minimally invasive approach. The appropriate indication of THLPA is to treat filmy, especially mild pelvic adhesions. It could partly avoid transabdominal operative laparoscopy for the infertile women.
Hu
Xiao-Liang
XL
Department of Obstetrics and Gynecology, Affiliated Second Hospital, Jinan University Medical College, Shenzhen 518020, China. Email: hu6622@163.com.
Xu
Li-Mei
LM
D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female; D010535:Laparoscopy; D010388:Pelvis; D000267:Tissue Adhesions