Safety and efficacy of postoperative continuous intra-peritoneal wash with lactated Ringer's for minimizing post-myomectomy pelvic adhesions: a pilot clinical trial
Ahmad M. Abu-Elhasan¹, Mohamad S. Abdellah¹, Hossam O. Hamed¹׳²
¹Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Egypt
²Department of Obstetrics and Gynecology, Qassim University, Burraidah, Saudi Arabia.
European Journal of Obstetrics & Gynecology and Reproductive Biology (Accepted for publication and published online)
ABSTRACT
Objectives: Intra-abdominal adhesion is a common morbidity after laparotomic myomectomy. We tried to determine whether post- myomectomy intra-peritoneal wash with lactated Ringer's for 48 hours may reduce the incidence or degree of adhesions.
Methods: A prospective, randomized trial that included 52 eligible participants for whom abdominal myomectomies were done. Participants were randomly allocated into a treatment group (n=26), which was subjected to continuous intra-peritoneal wash for 48 hours via two intra-peritoneal drains, and a control group (n=26) with no further postoperative intervention. The incidence of de novo adhesions, its severity and extent were scored at a second look laparoscopy 8-10 weeks postoperative. Adhesions were graded using Local Adhesion Barrier Scoring System (LABS) score. Adverse effects were also assessed and reported.
Results: There was no statistically significant difference as regard duration of hospital stay or the incidence of adverse events. A significantly high proportion of adhesion-free patients was found in the treatment group [11/ 23, 47.8%] compared to control group [4/21, 19%] (P < 0.01). The mean number of pelvic sites covered by adhesions was significantly low in treatment group compared to control group (2.2±0.3 versus 4.6±0.8, P < 0.05). The total adhesion score was significantly low in treatment group compared with controls (2.1±0.5 versus 4.8±1.4, P < 0.05). Also, adhesion score was significantly low at most of the individual anatomical sites in treatment group compared with controls.
Conclusion: Our results suggest that application of postoperative intraperitoneal wash with lactated Ringer's solution for 48 hours may have a reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy.
Key words: intra-peritoneal wash, lactated Ringer's, myomectomy, pelvic adhesions.
