The place of laparoscopic sterilization following previous abdomino-pelvic surgery - abstract

ABSTRACT

From 1991, women with previous pelvic surgery and who requested laparoscopic sterilization were evaluated clinically to determine their suitability for safe laparoscopic sterilization. Women who gave a history of postoperative sepsis or who had evidence of puckering of the surgical scar, immobility of the uterus and adnexae as well as the presence of a midline incision extending through the umbilicus were excluded. Forty women were evaluated, seven were found to be unsuitable by the above criteria. The other thirty-three had safe laparoscopic sterilization with no failures. The study also related the presence of intra abdominal adhesions with respect to the type of incision at Caesarean Section and other non-obstetric surgery. Adhesions were found in 9 of the 22 (41 percent) women who underwent caesarean section. Two of the other nine women were free of adhesion. In contrast, 7 of the 11 (64 percent) women with pfannestiel incisions had adhesions. There were adhesions in 4 of 11 women with non-obstetric surgery. In this group, 3 of the 4 women with midline scars and 1 of the 2 women with appendectomy scars had adhesions. The absence of injury to omentum and bowel in this study compares favourably to the 6 percent incidence noted in a similar but larger study published in early 1995. The low incidence of adhesions after midline scars at caesarean section is worth noting, especially since in our setting, women with this type of incision have traditionally been denied laparoscopic sterilization. It may be that the large postpartum uterus confers some degree of protection between the inferior surface of the midline abdominal incision and the bowel and omentum. It is felt that women with previous abdomino-pelvic surgery who request sterilization can benefit from safe laparoscopic sterilization using the above clinical screening criteria (AU)