Adhesion formation after laparoscopic resection of uterosacral ligaments in women with endometriosis

Charles Chapron, Juliette Guibert, Arnaud Fauconnier, Marco Vieira, Jean Bernard Dubuisson

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objective. To analyze the risk of postoperative adhesions in women who undergo laparoscopic surgical management of deep endometriosis infiltrating the uterosacral ligaments (USL). Design. Retrospective analysis (Canadian Task Force classification II-2). Setting. University-affiliated hospital. Patients. Forty-six women with deep endometriosis infiltrating the USL. Intervention. Laparoscopic resection of all USL with deep endometriotic lesions and excision of all other endometriotic lesions, followed by second-look laparoscopy. Measurements and Main Results. At second-look laparoscopy, 15 patients (32.6%) had no adhesions at the site where the USL had been resected, 24 (52.2%) had filmy avascular adhesions, and 7 (15.2%) had dense or vascular adhesions. No patient had adhesions of the binding type. Only two factors, the revised American Fertility Association (rAFS) score at initial laparoscopy and surgical modality (unilateral resection of the right USL, unilateral resection of the left USL, bilateral resection of USL) had a statistically significant influence on the risk of postoperative adhesions occurring. After adjustment, the relation with initial rAFS stage and surgical modality remained significant in the stepwise logistic regression model. Conclusion. These encouraging results are particularly interesting for patients with infertility due to pelvic pain syndrome. Second-look laparoscopy should not be performed routinely after laparoscopic management of deep endometriosis infiltrating the USL. We propose that it be reserved for women with rAFS stages III and IV endometriosis, especially when lesions are located on the left side.

Original languageEnglish
Pages (from-to)368-373
Number of pages6
JournalAmerican Association of Gynecologic Laparoscopists
Volume8
Issue number3
DOIs
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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