title: Association between uterine repair at laparoscopic myomectomy and postoperative adhesions.
abstract: OBJECTIVE
  To determine whether uterine repair at laparoscopic myomectomy influences postoperative adhesions.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  A total of 108 patients who underwent second-look laparoscopy after laparoscopic myomectomy without concomitant pelvic surgery between January 2006 and May 2010.
  
  
  METHODS
  Absorbable cellulose adhesion barriers were used for uterine repair at initial surgery in all women. The presence of adhesions was evaluated by second-look laparoscopy.
  
  
  METHODS
  The influence of background factors (diameter of largest myoma, number of myomas, incision sites and number of suture layers) and the uterine status immediately after uterine repair at laparoscopic myomectomy (number, length and location of wounds, as well as wound appearance classified as virtually normal, swollen or protruding) on adhesion formation were analysed in 108 women with 296 uterine wounds. Data were analysed by logistic regression analysis.
  
  
  RESULTS
  Forty-one (38.0%) women had adhesions to their uterus at follow up. We identified 48 (16.2%) adhesions among 296 wounds in all women. A protruding wound was significantly associated with postoperative wound adhesion (odds ratio, 2.53; p=0.02). The number of enucleated subserosal myomas (odds ratio, 3.29; p<0.001) and the diameter of the largest myoma (odds ratio, 1.05; p<0.001) were significantly associated with wound protrusion, which was a critical factor influencing adhesion.
  
  
  CONCLUSIONS
  Postoperative wound adhesion formation seems to depend on uterine status immediately after laparoscopic myomectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. kumakiri@juntendo.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Shozo
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Ayako
authors.initials: A
authors.lastname: Kono
authors.forename: Rie
authors.initials: R
authors.lastname: Ozaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
mesh_terms: D000328:Adult; D002482:Cellulose; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D012189:Retrospective Studies; D013523:Surgical Equipment; D000267:Tissue Adhesions / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D014594:Uterine Neoplasms / Q000601:surgery*
chemical_list: D002482:Cellulose