Adhesions after laparoscopic myomectomy: effect of the technique used

Objective To evaluate the technique of laparoscopic myomectomy and to assess the effect of injection of a vasoconstrictive agent on the incidence of postoperative adhesions. Design Prospective randomized clinical study. Setting University-based and a tertiary referral private centre. Patients 38 patients with subserous-interstitial myomas, 3-7 cm in diameter, who were recruited from 99 women scheduled for laparoscopic myomectomy during the period from September 1994 till March 1997. Interventions The patients were randomly assigned to receive an injection of Ornipressin (group I, 21 patients) or no injection (group II, 17 patients) prior to myomectomy. Main outcome measures The incidence, type and degree of pelvic adhesions, evaluated at follow-up laparoscopy 1 month after the original procedure. Results The procedure was easier and less time-consuming in group I, compared with group II. The incidence of pelvic adhesions was higher in group I compared with group II and the adhesions were more vascular in group I. Conclusion The technique of laparoscopic myomectomy is feasible and safe. The incidence of postoperative pelvic adhesions is affected mainly by the technique used. Vasoconstricting agents make laparoscopy more convenient to the surgeon, but give a false impression of suitable haemostasis; our preliminary results indicate that their use may increase the incidence of pelvic adhesions.