Page 17 - Journal of Laparoscopic Surgery - WALS Journal

WJOLS

Laparoscopy in Gynecology
there were nine (15.8%) cases of unexplained fertility. In makes it an attractive option. Additionally in clomiphene-
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a study by Samal et al no obvious cause could be found resistant patients who can’t come for stringent follow-up
in 18% cases of infertility. which is required in cases of gonadotropin treatment,
In patients with CPP who underwent diagnostic LOD is a safe option.
laparoscopy, one-fourth had endometriosis. This incidence Half of our cases with CPP showed adhesions.
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was higher in a study by Triolo et al where one-third of Hao et al concluded in their study that pelvis adhesions
cases who underwent laparoscopy for CPP were found to are characteristic lesions of endometriosis, the site
have endometriosis. Only adhesions were found in 50% and degree of which are closely correlated with pain
of patients in our study with CPP. According to Neis and symptoms. Adhesiolysis of deep/dense adhesions has
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Neis in nearly one-third of the cases the reason for pain been shown to be of proven benefit. 15,16
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is endometriosis, and in another one-third, adhesions In a study by Eltabbakh et al, laparoscopic man-
are responsible for pain. In 1 (25%) case, no cause could agement of benign ovarian cysts (mucinous/serous
be found for pain. The reason for pain in these cases cystadenoma, dermoid cysts, endometriosis, etc.) with
of normal pelvic findings could be pelvic congestion. cystectomy or oophorectomy is a feasible and safe option
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Gelbaya and El-Halwagy have even labeled the role of for women with a short hospital stay. Ten patients in our
laparoscopy in CPP as controversial as in 40% of cases study underwent laparoscopic cystectomy safely.
no obvious etiology is found when it is done. However, Cauterization of endometriotic spots was another
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in a study by Sharma et al, the commonest finding on common intervention done in our study group. Seiler et al
laparoscopy was adhesions in 40%, endometriosis in 18%, have also concluded in their study that electrocautery
and pelvic congestion syndrome in 20%, while 10% of is safe and effective in the treatment of moderate endo-
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patients had normal pelvis. metriosis. According to a study by Osuga et al, minimal/
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Samal et al studied 100 infertile women who under- mild endometriosis benefited the most from laparoscopic
went laparoscopy. Tubal cause was found in 34% cases, manipulation when tubal adhesions are present.
ovarian in 27% and peritoneal factor (endometriosis, Role of laparoscopic salpingectomy for management
genital TB, adhesions) in 7% cases. Uterine cause was of ectopic pregnancy has been emphasized in many
seen in 14% cases and 18% were found to have no obvious studies till date. 20-22 In our study all three ectopic preg-
cause. Similar findings were seen in our study where nancies and one patient with previous tubal ligation
tubal factor was seen in 32.75% and ovarian in 22.4%. failure and another with bilateral massive pyosalpinx (not
In our study, peritoneal factor (25.9%) was much more responding to medical management) were managed with
common than uterine factor (3.44%). laparoscopic salpingectomy. Seven patients in our study
Regarding intraoperative findings in patients with underwent salpingo-oophorectomy and fimbrial dilata-

previous history of TB, we had two (33.33%) patients tion was done in one patient who had fimbrial block on
with adhesions only, two (33.33%) with adhesions along hysterosalpingography. In four patients, the procedure
with endometriosis, and hydrosalpinx in another one had to be converted to open laparotomy in view of dense
(16.67%) patient. The results were very similar to the adhesions and difficult approach to pelvic organs.
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study by Sharma et al in which 85 women with previous
history of genital TB were studied and various grades CONCLUSION
of pelvic adhesions were found in 65.8% patients and
hydrosalpinx in 17.6% patients. Laparoscopy succeeds in detecting many pelvic patholo-
Of the interventions, the most common procedure gies which are difficult to diagnose on clinical examina-
performed during laparoscopy in our study was ovarian tion. It has strengthened its position as a gold standard
drilling (12) followed by adhesiolysis in 11 cases and in evaluation of infertility, CPP, and endometriosis.
cystectomy and cauterization of endometriotic spots Management in the same sitting makes it a safe, feasible,
in ten patients each. A total of 12 patients underwent economical, and less invasive modality for diagnosis and
laparoscopic ovarian drilling (LOD) in our study. These treatment of many gynecological conditions.
were the cases where either polycystic ovary syndrome
(PCOS) was incidental finding during laparoscopy or they REFERENCES
had anovulatory cycles. Although in a Cochrane database 1. Fatum M, Laufer N, Simon A. Investigation of the infertile
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review there was no significant difference in rates of couple: should diagnostic laparoscopy be performed after
clinical pregnancy, live birth, or miscarriage in women normal hysterosalpingography in treating infertility sus-
pected of unknown origin? Hum Reprod 2002 Jan;17(1):1-3.
with clomiphene-resistant PCOS undergoing LOD 2. ACOG Committee on Practice Bulletins—Gynecology. ACOG
compared to medical treatment, the decrease in number Practice Bulletin No. 51. Chronic pelvic pain. Obstet Gynecol
in multiple pregnancies in patients undergoing LOD 2004 Mar;103(3):589-605.
World Journal of Laparoscopic Surgery, January-April 2016;9(1):13-16 15