Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy.

摘要

OBJECTIVE: To determine the incidence, site, and grade of ovarian adhesion formation after laparoscopic ovarian drilling (LOD) and analyze the association between the number of punctures made and the incidence and grade of adhesions, and evaluate the lateral distribution of the adhesions. DESIGN: Prospective clinical study. SETTING: University hospital endocrine and infertility center. PATIENT(S): Ninety-six anovulatory infertile women with polycystic ovarian syndrome (PCOS) treated with LOD. INTERVENTION(S): Women were randomized into two study groups of 48 women each, one treated with 6 punctures on the left ovary and 12 on the right, and the other treated with 6 punctures on the right ovary and 12 on the left. A short-term second-look minilaparoscopy was performed to evaluate postsurgical adhesion formation. MAIN OUTCOME MEASURE(S): [1] Evaluation of the incidence and grade (thin, dense, cohesive) of ovarian adhesions; [2] comparative analysis of the incidence and grade of ovarian adhesions between ovaries treated with 6 and 12 punctures; and [3] comparative analysis of the incidence and grade of ovarian adhesions between the two sides. RESULT(S): Adhesion formation was detected in 54 of the 90 women (60%) and in 83 of the 180 ovaries treated (46%). Dense adhesions were more likely to develop on the left ovaries to a statistically significant extent, and independently of the number of ovarian punctures performed (odds ratio [OR] = 4.34, 95% confidence interval [CI] = 1.72-10.94). Logistic regression analysis showed that the incidence of ovarian adhesions was independent of both number of punctures (OR = 1.05, 95% CI = 0.58-1.88) and side (OR = 1.37, 95% CI = 0.76-2.46). CONCLUSION(S): The incidence of ovarian adhesion formation after LOD was high, and their extent and severity was not influenced by the number of ovarian punctures; however, the left ovary appeared more prone to develop severe adhesions than the contralateral one.