|June 2003 · Vol. 15, No. 6
Preventing adhesions after abdominal myomectomy: Tools and techniques
Without preventive strategies, adhesions develop in more than half of women who undergo this procedure. Here, a review of protective adjuvants.
Dr. DeCherney is professor and Dr. Chang and Dr. Marin are clinical fellows, department of obstetrics and gynecology, division of reproductive endocrinology and infertility, David Geffen School of Medicine at the University of California,
To reduce the incidence of postoperative adhesions, follow basic principles of microsurgery: Minimize the number and extent of incisions, handle all tissue gently, strive for absolute hemostasis, and use small, nonreactive suture.
Despite limited data from prospective, randomized studies, both fluid and barrier adjuvants have proved effective in reducing the incidence and extent of adhesions after abdominal myomectomy.
Abdominal myomectomy is the preferred treatment in women with large or numerous intramural myomas, especially in the setting of infertility, recurrent pregnancy loss, and preservation of future fertility.1,2 However, postoperative adhesions are distressingly common following this procedure, resulting in significant potential morbidity. Fortunately, a number of products can reduce their occurrence. Proper surgical techniques and a thorough knowledge of these products are invaluable in helping reduce the incidence of adhesions.
The association between adhesions and diminished fertility is well-established,3,4 particularly when peritubal involvement is present (FIGURES 1-3). Abdominopelvic adhesions also contribute to significant chronic pelvic pain, bowel obstruction, and technical difficulty in subsequent surgical or assisted-reproduction procedures.5 Unfortunately, most attempts at adhesiolysis meet with less than complete success, since adhesions recur in 55% to 100% of patients (FIGURE 4).6 Thus, preventing adhesions in the first place would seem to be key to successful outcomes in abdominal myomectomy.