Early laparoscopy after pelvic operations to prevent adhesions: safety and efficacy

Laparoscopy 12 days after 256 consecutive operations for infertility allowed early diagnosis and treatment of postoperative adhesions that might otherwise have jeopardized the result. Despite scrupulous microsurgical techniques, complete absence of adnexal adherences was present in only 31 of 73 (42.5%) patients without initial adhesions and in 15 of 183 (8.2%) patients who had adhesions lysed. New or reformed adhesions usually were easily separable, often without bleeding, and often with much apparent improvement in fimbrio-ovarian anatomy. There were no significant complications and the safety of early postoperative (second-look) laparoscopy seems established. A modification of the 1979 American Fertility Society endometriosis scoring system was used to quantitate adhesions in 38 patients who subsequently underwent an additional (third-look) pelvic procedure. Adhesions were worse as a result of the laparoscopy in no patients, unchanged in 5 patients, and improved in 33 patients; overall, there was a significant reduction in median adhesion scores from 8 at laparoscopy (95% confidence limits of median, 6 to 10) to 2 at final observation (95% limits, 0 to 4; P less than 0.001, rank sum test). Laparoscopy between the time of serosal healing (8 days) and established adhesion fibrosis (21 days) is a safe and effective way of reducing peritoneal adhesions after pelvic operations in young women.