Severe adhesions
Category II - dense adhesions with vessels, “bricked up” ovaries and tubes, involvement of the intestine and omentum: separation requires careful work at the intestinal wall and ureter with coagulation of the vessels, and sometimes restoration of the fimbrial part of the tube. The operation relieves chronic pain and, if the tubes are preserved, gives a 30–40% chance of pregnancy; in case of significant damage to the tubes, the surgeon recommends IVF, but the performed adhesiolysis facilitates the collection of eggs. Anti-adhesive barriers and early activation reduce the risk of re-formation of adhesions.
Indications
- tubo-peritoneal infertility: adhesions around the tubes and ovaries, obstruction of the tubes in the ampullary section, hydrosalpinx;
- adhesions after inflammation and operations with pelvic pain;
- preparation for IVF (restoration of anatomy, removal of hydrosalpinx);
- voluntary surgical sterilization at the request of a woman (by law - from 35 years of age or with 2+ children, for medical reasons).
Chances of pregnancy
After separation of adhesions and tubal plasty with preserved mucosa, pregnancy occurs in 30–60% of women within 1–2 years (higher with category I adhesions and young age), the risk of ectopic pregnancy is 5–10% - therefore, after surgery, early ultrasound monitoring is necessary if there is a delay. In case of severe damage to the tubes (thin wall, lack of folding), IVF is more effective, and hydrosalpinx is removed or bandaged before IVF, since its fluid reduces implantation. Chromohydrotubation during surgery confirms restored patency.
Benefits of laparoscopy
Laparoscopy is the standard of modern operative gynecology: magnifying the image by 10–15 times allows you to work more accurately than an open operation and is more gentle on the ovarian tissue and tubes, blood loss is minimal, adhesions form less frequently (important for future pregnancy), the pain after the operation is mild, and the patient gets up on the day of the operation and is discharged on the 1st–3rd day; Instead of a cut, three barely noticeable scars remain. In the clinics below, laparoscopic operations are performed by gynecological surgeons with extensive experience on modern endoscopic stands.
Risks and contraindications
- rare complications: bleeding, injury to neighboring organs, infection, thrombosis - prevention and the experience of the surgeon reduce the risk to a minimum;
- contraindications: severe heart and lung diseases, coagulation disorders, severe adhesions after many operations, large tumors (>15–20 cm) - then laparotomy is chosen;
- Obesity and previous operations are not a contraindication, but require an experienced team.
