Risk of adhesions formation following microsurgical monopolar laparoscopic ovarian drilling: a comparative study

The objective of the study was to determine the prevalence, extent, and location of adhesion formation following microsurgical monopolar laparoscopic ovarian drilling (LOD) among fertile and infertile women with clomiphene-resistant polycystic ovaries (PCO). The design was a longitudinal cohort follow-up study. The study was performed at the endoscopic unit of a tertiary university center. Three hundred and forty-seven patients with PCO were scheduled for LOD as a treatment option for clomiphene-resistant anovulation. Microsurgical monopolar LOD was performed in all cases. Two hundred and forty-six patients without possible additional predisposing factor for postoperative adhesion formation were followed up. To assess the sole effect of LOD on adhesion formation, only 51 eligible patients were classified into two groups; Group A comprised 22 women who conceived within 6 months following LOD and subjected to cesarean section, while group B included 29 women who failed to conceive over the same period of time and subjected to second-look laparoscopy. The main outcome measure was an evaluation of the prevalence, side, site, and severity of pelvic adhesions following microsurgical monopolar LOD. In total, adhesions were diagnosed in 40 cases (78.4%). Adhesions were diagnosed in 15 cases (68.1%) and 25 cases (86.2%) in groups A and B, respectively, without a statistically significant difference ( p = 0.21). Periovarian adhesions were diagnosed in 47/51 (92%) of cases in both groups. In 29 (56.8%) cases in both groups, adhesions were diagnosed on both sides (right and left adnexae) divided as eight (36.3%) and 21 (72.4%) in groups A and B, respectively, with a statistically significant difference ( p = 0.01). The documented high prevalence of adhesions among infertile as well as women who conceived following LOD is an added evidence to the established risk of post-LOD adhesion formation. Following microsurgical principles would minimize the risk of these adhesions except periovarian adhesions. There is a bad need for studies on more refinement of LOD to make it as less adhesiogenic procedure as possible.