الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Laparoscopic adhesiolysis offeres a useful alternative to laparotomy techniques and can be performed easily and safely. Sixty patients with pelvic adhesions presented with infertility and chronic pelvic pain were selected and subjected to laparoscopic adhesiolysis done at the endoscopic unit of Benha University Hospital. Careful assessment and preparation of these patients was carried out prior to the endoscopic surgery. A full history taking, a thorough general, abdominal and pelvic examination and investigations were done including evaluation of ovulation by timed premenstrual endometrial biopsy, evaluation of tuba! patency by hysterosalpingography and evaluation of male factor by a recent semen analysis.
Laparoscoic adhesiolysis was carried out and based on the visual impression and finding at the time of the procedure. The procedure was performed under general anaesthesia with controlled ventilation. Initial inspection of the pelvis was performed and the decision to lyse adhesions via laparoscopy was governed by the American Fertility Society classification of pelvic adhesions (1988). Three punctures laparoscopic technique was performed.
In the present study, 38 (63.33%) cases had primary infertility, 12 cases (20%) had secondary infertility and 10 cases (16.67%) with chronic pelvic pain. Nearly, 2/3 of the cases (68.42%) lied in two age groups from 25-30 and from 30-35 years. Peritubal adhesion were found in 20%, periovarian adhesions in 30%, perituboovarian in 36.67% and general pelvic adhesions in 13.33% of cases. Minimal adhesions were found in 33.33%, mild adhesions were found in 50%, moderate adhesions in 10% and severe adhesions in 6.67% of cases.
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Pelvic infection (56.67%) was the commonest cause of pelvic adhesions. Preoperative tubal patency was found in 53.33% and 60% on the right and left side respectively by hysterosalpingography. Intraoperative tubal patency was demonstrated in 63.33% and 66.67% on the right and left side before adhesiolysis and in 81.67% and 86.67% respectively after the procedure. Postoperative tubal patency was achieved by chromopertubation, after 8 weeks from the first procedure and during the second-look laparoscopy in 80% and 83.33% respectively before a second adhesiolysis and increased to 83.33% and 90% respectively following the lysis of the reformed adhesions.
The surgical technique involved was laparoscopy and visualization, chromopertubation to assess tubal patency, adhesiolysis and hemostasis by endocoagulation or electrodiathermy, and pelvic lavage using Ringer’s lactate solution. The operative technique showed some variation from one patient to another depeding on the site, the type as will as the extent of the pelvic adhesions.
At the second look laparoscopy, the pelvis was free from adhesion in 60% of cases subjected to lysis using electrodiathermy and 93.33% of cases subjected to lysis using endocoagulation. No improvement occurred in 10% of cases lysed by the electrodiathermy. In the present study, there was no significant major complications reported and all of them were minor.
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CONCLUSION AND RECOMMENDATIONS
With appropriately selected patients and in trained hands, laparoscopic adhesiolysis is a low risk procedure associated with a surprisingly good success rate if the endocoagulator is used in comparison with the electrodiathermy. It can be performed on a day-care basis in terms of both hospital stay and avoidance of major abdominal surgery.