Association between uterine repair at laparoscopic myomectomy and postoperative adhesions

Objective. To determine whether uterine repair at laparoscopic myomectomy influences postoperative adhesions. Design. Retrospective study. Setting. University‐affiliated hospital. Population. A total of 108 patients who underwent second‐look laparoscopy after laparoscopic myomectomy without concomitant pelvic surgery between January 2006 and May 2010. Methods. Absorbable cellulose adhesion barriers were used for uterine repair at initial surgery in all women. The presence of adhesions was evaluated by second‐look laparoscopy. Main outcome measures. The influence of background factors (diameter of largest myoma, number of myomas, incision sites and number of suture layers) and the uterine status immediately after uterine repair at laparoscopic myomectomy (number, length and location of wounds, as well as wound appearance classified as virtually normal, swollen or protruding) on adhesion formation were analysed in 108 women with 296 uterine wounds. Data were analysed by logistic regression analysis. Results. Forty‐one (38.0%) women had adhesions to their uterus at follow up. We identified 48 (16.2%) adhesions among 296 wounds in all women. A protruding wound was significantly associated with postoperative wound adhesion (odds ratio, 2.53; p=0.02). The number of enucleated subserosal myomas (odds ratio, 3.29; p<0.001) and the diameter of the largest myoma (odds ratio, 1.05; p<0.001) were significantly associated with wound protrusion, which was a critical factor influencing adhesion. Conclusions. Postoperative wound adhesion formation seems to depend on uterine status immediately after laparoscopic myomectomy.