Page 12 - WJOLS - Surgery Journal

Cyriac Pappachan
endometriosis, Oxiplex/AP Gel worked well to prevent an Four adnexa in the control group and 5 adnexa in the treatment
increase in adhesion score. Oxiplex/AP Gel did not appear to group had adhesion scores in the mild category at the initial
provide that benefit to patients with grade four endometriosis surgery. In the Oxiplex/AP Gel treated group, 1 had a worse
(Data not shown). score (moderate) at second look and 2 had a better adhesion
Seeing the number of patients whose adhesion score shift score (minimal). In contrast to this, in the control group, all the
to a better category of adnexal adhesion score after surgery, four had worse adhesion category at the second look. 3 were
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the individual patient benefit can be demonstrated. For moderate and 1 was severe. In the moderate group at initial
patients, the prognosis is worse if there is increase in adnexal surgery, out of 5 adnexa that received Oxiplex/AP Gel, 3 had a
adhesion score. better adhesion score at second look (2 minimal and 1 mild) and
As shown in Table 1, the prognostic categories for minimal 1 had a worse score. In control group, in moderate category at
(0-5), mild (6-10), moderate (11-20) and severe (21-32) scores are first surgery, out of 5, 4 adnexa had worse adhesion scores at
provided for each of the patient group. 23 adnexa had a minimal second look (1 moderate and 4 severe).
base line adhesion score (Row-1) in the AP Gel/ Oxiplex treatment In the treated adnexa with severe adhesion scores at first
group. 22 of these remained in the minimal group. One of them look, 2 had stage three and 6 had stage four endometriosis. At
shifted to mild at second look. In this one patient, review of gel second look all these remained in severe category. At second
application showed that adnexal surgical sites were not covered look, of the 4 adnexa in the severe category that did not have
by the gel at the end of the surgery. Hence it is not known what endometriosis, 2 were in moderate group, 1 in mild and 1 in
would have been in the second look adhesion score, if the minimal group. At initial surgery in the control patients, 9 adnexa
adnexum was covered with gel in a similar manner to the other were in the severe group. Of these, 6 had stage four
22 adnexa of this category. In control population, at the initial endometriosis and they remained in severe category at second
surgery, 23 adnexa were in the minimal category. During second look. The other 3 adnexa that were severe at the initial surgery
look, 13 remained unchanged, 7 mild, 1 moderate and 2 severe. and were not in patients with stage four endometriosis, better
All together 10 had shifted to higher category. These differences adhesion score in the second look was seen only in 1. The
in shift analysis are significant (p < 0.01). other 2 adnexa stayed severe. In the shift table, these changes
The significant benefit of Oxiplex/AP Gel in reducing were statistically significant (p < 0.01).
adhesions was shown by both a reduction in average AFS From the use of Oxiplex/AP Gel, the number of individual
score as well as reduction in AFS prognostic category as a adnexal adhesion scores (Table 2) that improved or stayed the
result of treatment (P < 0.01 for both). same from first to second look laparoscopy versus those that

Table 1: Shift analysis (Cochran-Mantel-Haenszel statistic)
Baseline American Fertility Society (AFS) category Total Second-look AFS scores
Minimal Mild Moderate Severe
(0-5) (6-10) (11-20) (21-32)
Treatment surgery + Oxiplex/AP Gel
Minimal (0-5) 23 22 1 0 0
Mild (6-10) 5 2 2 1 0
Moderate (11-20) 5 2 1 1 1
Severe (21-32) 12 1 1 2 8
Total 45 27 5 4 9
Control: surgery only
Minimal (0-5) 23 13 7 1 2
Mild (6-10) 4 0 0 3 1
Moderate (11-20) 5 0 0 1 4
Severe (21-32) 9 0 0 1 8
Total 41 13 7 6 15

Table 2: Outcome of clinical trials using the adnexal adhesion score of the American Fertility Society (AFS) as established in 1988
Individual AFS scores AFS category
Improved or unchanged Worsened Total improved or unchanged Worsened Total
Oxiplex 87% (39) 13% (6) 45 93%(42) 6% (3) 45
Control 32% (13) 68% (28) 41 56% (23) 44% (18) 41

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