The significance of early second-look laparoscopy after myomectomy by laparotomy

Objective: The purpose of this study is to investigate the significance of early second-look laparoscopy (ESLL) and to evaluate post-operative adhesion formation after myomectomy by laparotomy.Patients: 57 women who wanted to conceive in the future underwent early second-look laparoscopy (ESLL) after myomectomy by laparotomy.Interventions: ESLL was performed to evaluate and to lyse post-operative adhesions at 7 to 14 days after myomectomy by laparotomy.Results: Post-operative adhesions were found in 39 patients and could be removed in 34 of them. Therefore, the efficacy rate of ESLL is about 0.6. Adhesions were found on sutured uterine muscles in 24 patients (42.1%), and new adnexal adhesions were identified in 23 patients (40.4%). The frequency of post-operative adnexal adhesions was similar between patients with and without simultaneous adenexal operations (41.2% vs. 40.0%), and the seriousness of those adhesions was also similar. The rate of post-operative adhesions in patients with endometriosis was significantly higher than that in patients without endometriosis (85.0% vs. 59.5%, p<0.05).Conclusions: Because the rate and the seriousness of post-operative adenexal adhesions were high after myomectomy by laparotomy, we need to make more provisions against adhesions. Because the frequency of adhesions after laparotomy was higher in patients with endometriosis, great care in preventing adhesions should be taken in all other gynecological operations as well.