Reduction of adhesions with fibrin glue after laparoscopic excision of large ovarian endometriomas

Study Objective. To evaluate the effect of fibrin glue on the formation of adhesions after laparoscopic excision of endometriomas. Design. Prospective case series. Setting. Department of Obstetrics and Gynecology at a university-affiliated hospital. Patients. Thirty women with ovarian cysts. Interventions. In 10 women (16 cysts) we performed laparoscopic resection of endometriomas leaving the ovarian capsule open. Twenty patients (25 cysts) underwent laparoscopic removal of endometriomas and fibrin glue approximation of the ovarian capsule, as well as coating of serosal defects with the glue. At second-look-laparoscopy 4 to 6 months after the initial surgery, postoperative adhesion formation was assessed according to the revised American Fertility Society classification. Measurements and Main Results. The mean (+/- SEM) adnexal adhesion score in patients without fibrin glue was 8.6 +/- 2.2 at initial surgery and increased slightly to 12.6 +/- 2.6 at second-look laparoscopy. In patients treated with fibrin glue, the score decreased significantly from 10.9 +/- 1.4 to 7.8 +/- 1.3 (p < 0.02). The decrease was most marked in women with endometriomas 5 cm or more in diameter and for those with a preoperative adhesion score of 8 or higher. Conclusion. Fibrin glue reduced postoperative adhesions after laparoscopic resection of endometriomas.