Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial

Objective: To determine if 3 months of preoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids. Design: Prospective, randomized, clinical study. Setting: A tertiary care medical center. Patient(s): Women of-reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal. Intervention(S): Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy for evaluating uterine adhesions after random allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery. Main Outcome Measure(s): Adhesion formation between treatment groups and by incision number and aggregate length. Result(s): Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo. For every additional centimeter of incision length, the total adhesion area over the uterine scrosal surface increased by 0.55 cm(2). The number of myomas removed and the number of incisions were positively correlated with total adhesion area. Conclusion(s): Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions. Following the standards of good surgical technique, adhesions are minimized with fewer and smaller incisions. (Fertil Steril(R) 2009;91:1909-13. (C) 2009 by American Society for Reproductive Medicine.)