Laparoscopic access in treatment of reproductive system diseases in women with multiple adhesions

Introduction . Recent progress in abdominal surgery and operative gynecology has led to a significant increase in the number of patients with postoperative abdominal adhesions. The incidence of adhesions after abdominal surgery reaches 67–95%, a serious health problem. In their presence, any following operations may be associated with an increased risk of intra- and postoperative complications. Objective. To study the possibility of laparoscopic access and its outcome in the surgical treatment of women with reproductive system diseases concomitant with pronounced abdominal and pelvic adhesions. Materials and methods . A retrospective analysis of 265 patient medical records was performed. The general group included 91 women who had undergone surgery for diseases of the reproductive system in the setting of pronounced abdominal and pelvic adhesions. The second group (control) comprised 174 patients who had undergone surgery for diseases of the reproductive system and had no adhesions. The average age of the patients in the general and control groups was 47.1 ± 12.8 and 46.5 ± 8.1 years, respectively. The preoperative examination included ultrasonography and dynamic magnetic resonance imaging (MRI) of the abdominal cavity and lesser pelvis. For laparoscopic surgery, a STORZ high-resolution video system (Germany) and a BOWA power plant (Germany), including high-frequency (HF) electric, laser, and argon plasma energy, were used. Statistical data processing was carried out using the Statistica 13 and MS Office Excel software. The result was considered statistically significant at p < 0.05. Results . The conducted comparative analysis demonstrated the possibility of using laparoscopic access for the treatment of women with reproductive system pathologies in combination with pronounced abdominal and pelvic adhesions. The duration of surgery, the volume of blood loss, the severity of pain, the duration of hospitalization, and convalescence had no statistically significant differences between the general (n = 91) and control groups (n = 174). The absence of differences in the frequency of intra- and postoperative complications proves laparoscopic access to be safe in the setting of severe adhesions. The safety is ensured by preoperative patient preparation and examination, use of necessary modern equipment and tools, surgical skills and experience. Conclusions. The use of laparoscopic access for performing surgical treatment of patients with reproductive system diseases in combination with pronounced adhesions can be considered as the preferred and safe treatment method.