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Adhesion-prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look
Hiroyuki Takeuchi1, Mari Kitade, Iwaho Kikuchi
1Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. hirotake@med.juntendo.ac.jp
Objective:
To examine the adhesion prevention effects of 2 types of fibrin sealant after laparoscopic myomectomy (LM).
Study Design:
A prospective, randomized study (Canadian Task Force I) was conducted at a University-affiliated hospital. A total of 91 patients showing a minimal myoma > 5 cm, excluding pedunculated myomas, underwent LM alone: 32 patients in the control group, 29 in the fibrin gel group and 30 patients in the fibrin sheet group. After LM, postoperative adhesions were evaluated by second-look laparoscopy. The frequency of postoperative adhesions was the main outcome.
Results:
The frequency of postoperative adhesions of the uterus was significantly lower (p < 0.05) in the fibrin gel group, with 20/32 (62.5%) in the control group, 10/29 (34.5%) in the fibrin gel group and 20/30 (67.7%) in the fibrin sheet group. Although no significant differences were found in the incidence of de novo adnexal adhesions, the lowest rate was found in the fibrin gel group, with 4/32 patients (12.5%) in the control group, 2/29 patients (6.8%) in the fibrin gel group and 5/30 patients (16.7%) in the fibrin sheet group. No bilateral adnexal adhesions were observed in the 3 groups.
Conclusion:
After LM for myomas as large as > or = 5 cm, postoperative adhesions were observed in > or = 50% of patients. The use of fibrin gel after LM is recommended.
