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• W2024574513 abstract "ObjectiveTo evaluate pelvic adhesion formation in patients undergoing abdominal myomectomy after the use of gonadotropin-releasing hormone agonist (GnRHa) pre-operatively. Pelvic adhesions have been found to have estrogen and progesterone receptors (Fertil Steril, 1998, 69: 511-16), and primate model studies have noted decreased post-operative adhesion formation during hypoestrogenic states (Fertil Steril, 1996, 66: 140-7). This study seeks to corroborate these findings in a clinical context.DesignRandomized, double-blinded, prospective study in a tertiary care medical center.Materials and methodsAfter obtaining IRB approval and informed consent, twenty patients who planned to undergo myomectomy via laparotomy were prospectively randomized to two groups of ten. The first group received GnRHa for three months prior to surgery, while the control group received a placebo for a similar duration. Pre-existing adhesions were graded for severity, extent, and total area of involvement during the first operation. Myometrial incisions were made to remove all palpable myomas, with incision lengths recorded. All patients underwent a “second -look” laparoscopy two to three weeks after the initial operation in order to evaluate post-operative adhesion formation. Adhesion scoring was repeated. The ratio of mean incision length, number of myomas removed, first look and second look adhesion area, and ratio of incisional adhesion area/total myometrial incision length in cm (A/L ratio) was calculated and compared for both groups.ResultsFor the placebo group, the mean “severity” was 1.42 ± 0.76 and the “extent” score was 1.15 ± 0.45. In the GnRHa group, mean “severity” was 1.89 ± 1.20 and the mean “extent” was 1.22 ± 0.45. Neither of these is statistically different at the p<0.05 level. The mean number of myomas (6.0 vs. 6.2), mean incisional length (18.5 cm vs. 17.4 cm), mean first look adhesion area (7.3 cm2 vs. 0.4 cm2) and mean second look adhesion score (23.3 cm2 vs. 36.7 cm2) were not significantly different for the two groups (placebo vs. GnRHa). When comparing A/L ratios, the GnRHa group’s mean was 0.80 ± 0.32 and the placebo group’s mean was 0.97 ± 1.94, again, not a statistically significant difference.ConclusionPost-operative adhesions following myomectomy are commonly encountered. These findings suggest that post-operative adhesion formation depends on many factors, and that the use of GnRH-a pre-operatively, at least in this small study group, does not significantly change the risk of adhesion formation after myomectomy. ObjectiveTo evaluate pelvic adhesion formation in patients undergoing abdominal myomectomy after the use of gonadotropin-releasing hormone agonist (GnRHa) pre-operatively. Pelvic adhesions have been found to have estrogen and progesterone receptors (Fertil Steril, 1998, 69: 511-16), and primate model studies have noted decreased post-operative adhesion formation during hypoestrogenic states (Fertil Steril, 1996, 66: 140-7). This study seeks to corroborate these findings in a clinical context. To evaluate pelvic adhesion formation in patients undergoing abdominal myomectomy after the use of gonadotropin-releasing hormone agonist (GnRHa) pre-operatively. Pelvic adhesions have been found to have estrogen and progesterone receptors (Fertil Steril, 1998, 69: 511-16), and primate model studies have noted decreased post-operative adhesion formation during hypoestrogenic states (Fertil Steril, 1996, 66: 140-7). This study seeks to corroborate these findings in a clinical context. DesignRandomized, double-blinded, prospective study in a tertiary care medical center. Randomized, double-blinded, prospective study in a tertiary care medical center. Materials and methodsAfter obtaining IRB approval and informed consent, twenty patients who planned to undergo myomectomy via laparotomy were prospectively randomized to two groups of ten. The first group received GnRHa for three months prior to surgery, while the control group received a placebo for a similar duration. Pre-existing adhesions were graded for severity, extent, and total area of involvement during the first operation. Myometrial incisions were made to remove all palpable myomas, with incision lengths recorded. All patients underwent a “second -look” laparoscopy two to three weeks after the initial operation in order to evaluate post-operative adhesion formation. Adhesion scoring was repeated. The ratio of mean incision length, number of myomas removed, first look and second look adhesion area, and ratio of incisional adhesion area/total myometrial incision length in cm (A/L ratio) was calculated and compared for both groups. After obtaining IRB approval and informed consent, twenty patients who planned to undergo myomectomy via laparotomy were prospectively randomized to two groups of ten. The first group received GnRHa for three months prior to surgery, while the control group received a placebo for a similar duration. Pre-existing adhesions were graded for severity, extent, and total area of involvement during the first operation. Myometrial incisions were made to remove all palpable myomas, with incision lengths recorded. All patients underwent a “second -look” laparoscopy two to three weeks after the initial operation in order to evaluate post-operative adhesion formation. Adhesion scoring was repeated. The ratio of mean incision length, number of myomas removed, first look and second look adhesion area, and ratio of incisional adhesion area/total myometrial incision length in cm (A/L ratio) was calculated and compared for both groups. ResultsFor the placebo group, the mean “severity” was 1.42 ± 0.76 and the “extent” score was 1.15 ± 0.45. In the GnRHa group, mean “severity” was 1.89 ± 1.20 and the mean “extent” was 1.22 ± 0.45. Neither of these is statistically different at the p<0.05 level. The mean number of myomas (6.0 vs. 6.2), mean incisional length (18.5 cm vs. 17.4 cm), mean first look adhesion area (7.3 cm2 vs. 0.4 cm2) and mean second look adhesion score (23.3 cm2 vs. 36.7 cm2) were not significantly different for the two groups (placebo vs. GnRHa). When comparing A/L ratios, the GnRHa group’s mean was 0.80 ± 0.32 and the placebo group’s mean was 0.97 ± 1.94, again, not a statistically significant difference. For the placebo group, the mean “severity” was 1.42 ± 0.76 and the “extent” score was 1.15 ± 0.45. In the GnRHa group, mean “severity” was 1.89 ± 1.20 and the mean “extent” was 1.22 ± 0.45. Neither of these is statistically different at the p<0.05 level. The mean number of myomas (6.0 vs. 6.2), mean incisional length (18.5 cm vs. 17.4 cm), mean first look adhesion area (7.3 cm2 vs. 0.4 cm2) and mean second look adhesion score (23.3 cm2 vs. 36.7 cm2) were not significantly different for the two groups (placebo vs. GnRHa). When comparing A/L ratios, the GnRHa group’s mean was 0.80 ± 0.32 and the placebo group’s mean was 0.97 ± 1.94, again, not a statistically significant difference. ConclusionPost-operative adhesions following myomectomy are commonly encountered. These findings suggest that post-operative adhesion formation depends on many factors, and that the use of GnRH-a pre-operatively, at least in this small study group, does not significantly change the risk of adhesion formation after myomectomy. Post-operative adhesions following myomectomy are commonly encountered. These findings suggest that post-operative adhesion formation depends on many factors, and that the use of GnRH-a pre-operatively, at least in this small study group, does not significantly change the risk of adhesion formation after myomectomy." @default.
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• W2024574513 title "Role of Preoperative Gonadotropin-Releasing Hormone Agonist in Post-Operative Adhesion Formation After Myomectomy" @default.
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