Association of previous abdominal surgery and significant adhesions in laparoscopic sterilization patients

Many surgeons believe that women who have undergone laparotomy are not good candidates for laparoscopic sterilization. Many of those women are admitted for minilaparotomy. However, women without previous surgery can also have adhesions. We compared the incidence of significant adhesions in women with and without histories of abdominal surgery. We also examined the outcomes in each group after 955 laparoscopic sterilizations. Two hundred sixty-three women (28%) had had previous surgery. Of them, 61 (23%) displayed significant adhesions. Of the remaining 692 patients, 19 (2.7%) had significant adhesions. There were no major complications in either group. Thus, a history of previous abdominal or pelvic procedures increased the risk of significant adhesion formation nearly tenfold. Since no major complications occurred in those women, we conclude that while such patients are at increased risk, that risk is not inordinate and does not justify the routine use of minilaparotomy.