David S. McLaughlin

Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery

At second-look laparoscopy, 82 of 161 women (51%) were noted to have adhesions at at least one new location. Such adhesions occurred at 31% of available sites. Among 121 women with adhesions at the initial operative procedure, the rate and type of recurrence assessed on the ovaries, fimbriae, and other sites were independent of the initial type. Additionally, neither the rate nor the type of adhesion recurrence observed at the time of second-look laparotomy was determined by the variable amount of time between the initial and second-look operative procedures. We conclude that reproductive pelvic surgical procedures are frequently complicated not only by adhesion reformation but by de novo adhesion formation as well.

Tubal patency and pelvic adhesions at early second-look laparoscopy following intraabdominal use of the carbon dioxide laser: initial report of the intraabdominal laser study group

It has been suggested that the carbon dioxide (CO2) laser, by virtue of its hypothetical capabilities for precise incisions, minimization of tissue handling and bleeding, and shortened operating time, may improve the success rate of gynecologic infertility surgery. To assess this hypothesis, a multicenter prospective study was performed to assess tubal patency and adhesion formation at early second-look laparoscopy after intraabdominal laser surgery. Procedures performed included salpingoneostomy, fimbrioplasty, lysis of adhesions, vaporization of endometriosis, and ovarian wedge resection. The results were compared with those of another multicenter prospective study that utilized nonlaser reconstructive pelvic surgery. Use of the CO2 laser was found to result in a greater tubal patency rate at the time of the second-look procedure. Adhesions present at the time of the second-look procedure were reduced from initial presentation at most sites; however, nonlaser infertility surgery appeared to have equal or greater efficacy in the prevention of adhesion formation at most sites. Thus, the CO2 laser does not appear to be a panacea for the treatment of tuboperitoneal causes of infertility. Pregnancy rates following intraabdominal use of the CO2 laser remain to be established.

Successful pregnancy outcome following removal of bilateral cornual polyps by microsurgical linear salpingotomy with the aid of the CO2 laser.

Various surgical approaches have been advanced to treat cornual obstruction secondary to intraluminal polyps. This case illustrates microsurgical principles incorporating the CO2 laser to maximize the preservation of normal uterotubal anatomy and function after excising large bilateral cornual polyps and multiple uterine myomata and vaporizing endometriosis and pelvic adhesions. The subsequent conception and delivery of a viable full-term infant demonstrates the efficacy of this new approach. Additional studies are warranted to further evaluate the role of microsurgical linear salpingotomy with the CO2 laser in the treatment of cornual polyps to enhance fertility.

Evaluation of adhesion reformation by early second-look laparoscopy following microlaser ovarian wedge resection**Presented at the Fortieth Annual Meeting of The American Fertility Society, April 2 to 7, 1984, New Orleans, Louisiana.††Color photographs supported in part by grants from Davis and Geck, Danbury, Connecticut; Olympus Corporation, Lake Success, New York; and American V. Mueller, Chicago, Illinois.

Early second-look laparoscopy, done 6 to 12 weeks postoperatively, was utilized to evaluate recurrent adhesion formation following microlaser ovarian wedge resection. Forty-nine ovaries in 25 consecutive infertility patients undergoing microlaser surgery for deep ovarian endometriosis or polycystic ovarian disease, refractory to medical treatment, were evaluated from October 1981 through March 1983. All patients subsequently underwent a second-look nonlaser laparoscopy to evaluate the extent of healing and to bluntly lyse any subsequent adhesions with the Olympus laparoscope (Olympus Corporation, Lake Success, NY) second-puncture probe: 36.7% of the ovaries had recurring adhesions, 83.3% of these adhesions were mild and filmy and 16.7% were moderate and dense. Additionally, four ovaries were viewed approximately 1 year postoperatively, with two ovaries that previously had mild and filmy adhesions lysed at 6 weeks having no recurrent adhesions. The actual pregnancy rate in this study is 60%, with 15 of the 25 patients conceiving at least once and 2 patients conceiving twice. The majority of pregnancies occurred within the first 6 months postoperatively, with the longest initial pregnancy occurring 22 months postoperatively. Thus, microlaser ovarian surgery, coupled with early second-look laparoscopy, appears efficacious in minimizing adhesion reformation and seems to have little adverse effect on subsequent conception.