[ NOTE: I have re-positioned some sentences in this abstract - in order to make this information easier to find and thus easier to understand by those of us who are not familiar with abstracts. ]
Incidence of adhesions after endoscopic myomectomy - Interceed TC7 versus Intergel
M. Korell, N. v. Obernitz*, H. Hepp*
Dept. OB/GYN, Klinikum Duisburg, D-47055 Duisburg, Germany
*Dept. OB/GYN, Klinikum Grosshadern, D-81366 Munich, Germany
Objectives
Recently, Intergel - a new gel composed of hyaloronic acid and ferric ion - was proposed to be instillated postoperatively for adhesion prevention. We examined the potential of Intergel in comparison to Interceed TC7 in patients with surgery for uterine fibroids.
Study Methods
70 women referred for operative laparoscopy because of uterine myoma were included in this study. The mean age was 35 years (min 23; max 42 years). After endoscopic myomectomy the patient was randomized.
In group A (n5), the suture area was covered with Interceed TC7 - a barrier consisting of methyl cellulose.
In group B (n5), we instilled Intergel in the pelvis to cover the whole uterus.
After a time interval of 4-8 weeks, a second look laparoscopy was performed. Here, the incidence and extent of adhesions to the uterus was examined.
Results
Until now, the second look laparoscopy ( SLL ) was performed in 48 of the 70 patients.
In 23 patients no adhesions were present, where in 19/48 women mild or severe adhesions (6/48) was found.
There were a tendency to more adhesion in group A.
With Interceed TC7, 10/23 patients showed no respectively 4/23 severe adhesions compared to 13/25 resp. 2/25 with Intergel.
All adhesions could be removed during second look laparoscopy inducing only minimal renewed serosal defects.
Conclusions
The formation of adhesions is very common after intraabdominal surgery repre-senting one of the major complications especially in reproductive surgery which may lead to infertility and abdominal symptoms going as far as ileus (Monk et al. 1994; Stone 1993).
Following myomectomy the incidence of postoperative adhesions reaches more than 90 % (Tulandi et al. 1993).
Many different methods were introduced to reduce the frequency and severity of adhesions but failed to prove clinical efficacy.
Only the use of the "barrier methods" like Interceed TC7 and Goretex SM can lead to a significant reduction.
The use of Interceed TC7 can increase the number of adhesion free patients from 12 % to 60 % (Larrson 1996).
According to our study, the new Intergel seems to offer the same or better efficacy in reduction of postoperative adhesions.
Adhesions following myomectomy - Interceed TC7 versus Intergel
method n SLL no medium severe adhesions
Interceed TC7 34 22 9/22 9/22 4/22
Intergel 33 24 13/24 9/24 2/24
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