Page 16 - Journal of Laparoscopic Surgery - WALS Journal

Nidhi Bhutani et al
written informed consent was taken and patients were Table 3: Intraoperative findings in cases of infertility (n = 58)
taken up for procedure under general anesthesia. Main cause of infertility Number of patients (%)
Preoperative findings were noted. Patients were Tubal factor 19 (32.75%)
assessed regarding indications for laparoscopy, intraop- Ovarian 13 (22.4%)
erative findings, and various interventions done during Normal pelvic findings 9 (15.5%)
the procedure. Tubal, ovarian, uterine, and peritoneal Peritoneal factor 15 (25.9%)
factors were assessed and further interventions were (a) Tubercular 4
(b) Endometriosis
done accordingly. Study was approved by the ethical Grade 1–2 6
committee of the institution. Grade 3–4 2
(c) Peritoneal adhesions 3
RESULTS Uterine causes 2 (3.44%)
A total of 75 women underwent laparoscopy during the Table 4: Findings in cases with history of tuberculosis and
study period. The mean age of study group was 28.44 chronic pelvic pain
years and majority of women were in the age group of In cases with previous history of TB Number of patients (n = 6)
21 to 30 years (Table 1). 1. Adhesions 2 (33.33%)
The main indication for laparoscopy was infertility 2. Endometriosis and adhesions 2 (33.33%)
followed by CPP and ovarian cysts. In three cases each of 3. Hydrosalpinx 1 (16.67%)
ectopic pregnancy and ruptured corpus luteal cyst where 4. Polycystic ovaries 1 (16.67%)
laparoscopy was carried out, patients were hemodynami- In cases with CPP Number of patients (n = 4)
cally stable. There were six patients of primary infertil- 1. Adhesions 2 (50%)
2. Normal
1 (25%)
ity who had previous history of tuberculosis (TB). One 3. Endometriosis 1 (25%)
patient with previous tubal ligation failure was managed
laparoscopically with bilateral salpingectomy (Table 2). Table 5: Interventions done during laparoscopy
In patients with infertility, tubal factor was the
commonest cause seen in 19 (32.75%) patients. Other Procedure Number of
patients*
causes were ovarian in 13 (22.4%), peritoneal (tubercular, Salpingo-oophorectomy (unilateral or bilateral) 7
endometrial, adhesions) in 15 (25.9%) and uterine causes Tubal ligation 6
(hypoplastic and unicornuate uterus with rudimentary Ovarian drilling 12
horn) in only 2 (3.44%) patients. Nine (15.5%) cases had Lysis of adhesions 11
unexplained infertility (Table 3). Salpingectomy 5
In majority of cases with previous history of TB and Cauterization of endometriotic spots 10
those with CPP, adhesions were found to be the reason Cystectomy 10
1
Fimbrial dilatation
for pain and infertility (Table 4).
*More than one procedure was done on some patients
Table 1: Age distribution of patients
Table 5 shows various interventions done during
Age (years) Number of patients (n) = 75 (%) laparoscopy. Ovarian drilling and adhesiolysis were the
21–25 20 (26.67%) most commonly done procedure. In four cases, procedure
26–30 37 (49.33%) was converted into laparotomy because of dense adhesions
31–35 12 (16%)
36–40 4 (5.33%) and difficulty in approaching the pelvic organs.
41–45 2 (2.67%)
DISCUSSION

In our study of 75 patients, 49.3% patients fell in the age
Table 2: Indications for laparoscopy (n = 75)
group of 26 to 30 years and 26.7% in the age group of 21 to
Factor Number of patients (n) = 75 (%)
Infertility 58 (77.33%) 25 years. This was probably because of infertility turning
Primary infertility 45 (77.6%) out to be the most common indication for laparoscopy.
6
Secondary infertility 13 (22.4%) Similarly in a study by Roupa al , 64.5% of patients with
Chronic pelvic pain 4 (5.3%) infertility were in the age group of 20 to 29 years.
Ectopic pregnancy 3 (4%) Of the total 58 patients with infertility, 77.6% had
Ruptured corpus luteal cysts 3 (4%) primary infertility and only 22.5% had secondary infertil-
Ovarian cysts 6 (8%) ity. The results were similar to the study of Avasthi et al
7
Previous Tubal ligation failure 1 (1.33%)
where 75% patients had primary infertility. In our study
14