Objective: To evaluate the incidence and the extent of postoperative adhesion formation in patients with polycystic ovarian disease (PCOD) who underwent laparoscopic ovarian electrocauterization.
Study design: Out of 118 patients with PCOD who underwent laparoscopic ovarian cautery at Department of Obstetrics and Gynecology of Benha University Hospital between October 1995 and March 1997, 46 patients were inrolled in this study to evaluate postoperative adhesion. Before the laparoscopic ovarian cautery all the patients showed the clinical features of the disease, elevated serum LH level and elevated testosterone (T) and they had the ultrasound features of polycystic ovaries. All cases had failed to ovulate after increasing doses of clomiphene citrate (CC) up to 150-mg/ day for 5 days. Diagnostic laparoscopy and methylene blue hydrotubation were performed before unipolar cautery. We restricted the number of diathermy bum to four per ovary irrespective of the ovarian size. Tne incidence and extent of pelvic adhesion formation subsequent to laparoscopic ovarian cautery was evaluated. In 29 patients the assessment of adhesions occurred during second look laparoscopy because of persisting infertility 10-13 months after laparoscopic ovarian cautery (group A) and cesarean section served as second look in further 17 cases who conceived after drilling and underwent abdominal delivery (group B). Pelvic adhesions were scored according to the Arneri9an Fertility Society classification of adnexal adhesions (1988), and the encountered adhesions were lysed.
Results: In this study, the occurrence of Pelvic adhesions was found in 25 cases (54 %). In group A, 18 cases (62%) had adhesions that were localiz~p' to periovarian site. The extent of encountered adhesions according to the American Fertility Society of adnexal adhesions were 13 cases had minimal adhesions, 2 cases had mild adhesion, and 3 cases had omental adhesions to the site of portal entry. The tubes were patent in all cases of this group. In-group B, pelvic adhesions were found in 7 cases (41 %). Minimal adhesions were found in 6 cases and one case of unilateral tuboovarian mass was reported.
Conclusion: The incidence of postoperative adhesions after laparoscopic ovarian cauterization was high. In most cases the adhesions were of minimal and mild types and did not affect the tubo ovarian function. However, in few cases the adhesions were moderate and in one case we found unilateral tubal block during cesarean section. So, the occurrence of pregnancy is no proof for patency of both tubes and/ or absence of pelvic adhesions. |
