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Objective: Chronic endometritis (CE) is an inflammatory condition with several different risk factors. We aimed to examine whether intrauterine abnormalities, such as endometrial polyps, submucosal myomas, intrauterine adhesions, or a septate uterus, were associated with an increased likelihood of developing chronic endometritis., Methods: A cross-sectional study was conducted on 335 infertile women who underwent hysteroscopy surgery at the Ayatollah Taleghani Hospital Infertility Center, affiliated by Shahid Beheshti University of Medical Sciences, in 2022. All participants in the study underwent hysteroscopic surgery, which allowed for direct visualization of the intrauterine cavity, and endometrial biopsies were taken for further analysis. To characterize endometritis, plasma cell infiltration was assessed. Patients with ≥5 plasma cells observed in 10 high-power fields were defined as having chronic endometritis., Results: Endometritis was observed in 51.3% of the patients, totaling 172 individuals. Logistic regression analysis revealed that patients with endometrial polyps had 5.2 times higher odds of developing endometritis compared to patients without polyps (95% CI = 2.9, 9.2) (p-value <0.001). Similarly, patients with intrauterine adhesions had a significant increase in the odds of endometritis (OR = 4.6, 95% CI = 2.1, 10.1) (p-value <0.001)., Conclusions: Treatment or removal of endometrial abnormalities through hysteroscopic procedures may help to reduce the risk of chronic endometritis and improve fertility outcomes. Further research is necessary.

Objective: Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach., Methods: A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769)., Results: Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62))., Conclusion: Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing., Level of Evidence: Level II., Competing Interests: Conflicts of interest The authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To examine demographic and obstetrical factors that are associated with adhesion formation following cesarean delivery., Methods: We conducted a population-based study that included all women over 18 years og age who underwent two cesarean deliveries between the years 1988 and 2016 in a large tertiary medical center. We excluded women with adhesions already diagnosed during the first cesarean delivery, history of other abdominal or pelvic surgery, history of pelvic infection or pelvic inflammatory disease, history of endometriosis and history of uterine Müllerian anomalies. In addition, women with a classical or T-shaped uterine incision, non-singleton pregnancies, and fetal chromosomal or structural abnormalities were excluded., Results: During the study period, 32.6% (n = 2283) of women were diagnosed with peritoneal adhesions during the second cesarean delivery. Factors found to be significantly associated with peritoneal adhesions were maternal age 35 years or older at the first cesarean delivery, Bedouin Arab ethnicity, composite of intrapartum and postpartum infectious morbidity, and cesarean deliveries that were performed after the onset of labor. In contrast, having a previous vaginal birth was found to be protective., Conclusions: Our results suggest that a woman's characteristics at her first cesarean delivery and her obstetrical history may be predictive of the likelihood of adhesion formation., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The aim of this systematic review is to examine the changing pattern of the causes, and outcomes of patients managed for AMBO in Nigeria., Methods: Relevant keywords relating to AMBO were used to conduct a search on PubMed, Web of Science, Google Scholar, and AJOL. The search returned 507 articles, which were subjected to title, abstract, and full text screenings, according to the inclusion and exclusion criteria. This generated 10 articles which were included in the final qualitative synthesis., Results: The total sample size across the 10 studies was 1033. Adhesions, hernias, and intra-abdominal tumors, responsible for 46.25%, 26.31%, and 12.23% of cases respectively, were the major causes of AMBO in Nigeria. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI: 17; 44, 5) and 11% (95% CI: 6; 15, 5), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria., Conclusions: Adhesion, which results predominantly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions, and postoperative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies, and it is significantly influenced by surgical intervention time., (© 2023 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: The purpose of this study was to evaluate the vaginal microecology and the distribution of human papillomavirus (HPV) subtypes in patients with uterine adhesions and explore the correlation between HPV infection and vaginal microecology imbalance and the occurrence of intrauterine adhesion (IUA)., Methods: A total of 479 women were enrolled in the study, including 259 in the normal group and 220 in the IUA group. Vaginal microecological and HPV analyses were performed on all participants. Significant differences between the two groups were analyzed, and Spearman correlation analysis was performed., Results: The incidence of IUA in patients between 31 and 40 years of age was high. The I-II degree of vaginal cleanliness in the IUA group was significantly lower than that in the normal group, and the number of III-IV degree was significantly higher than that in the normal group. Moreover, the incidences of VVC (vulvovaginal candidiasis) and vaginal disorders and infections with HPV 16 and HPV 52 subtypes were significantly higher in the IUA group than in the normal group. The incidence of high-risk HPV infection combined with vaginal disorders in the IUA group was higher than that in the normal group. Correlation analysis showed that the occurrence of IUAs was positively correlated with HPV infection and negatively correlated with PH and vaginal microecological imbalance., Conclusion: The HPV infection rate and vaginal microecology disorders affect the occurrence of IUAs. For patients with IUAs, control of the HPV infection rate and the prevention of vaginal microecological disorders should be improved., (© 2023. The Author(s).)

Study Objective: To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy., Design: A retrospective review study., Setting: An academic community hospital in the Boston metropolitan area., Patients: Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer., Interventions: All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy., Measurements and Main Results: A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs., Conclusion: Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study., (Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)

Purpose: Postoperative adhesions are a concerning complication of abdominal surgery with major implications on quality of life. This study aimed to investigate the risk factors for postoperative small-bowel obstruction (SBO) after colectomy for colorectal cancer., Methods: We reviewed the clinicopathological variables of 1646 patients who underwent colectomy for colorectal cancer between 2009 and 2018., Results: SBO occurred following primary tumor resection for colorectal cancer in 67 (4.1%) of the 1646 patients. The median observation period was 7.5 (range: 3.0-12.0) years. Multivariate analysis revealed that rectal tumors, anastomotic leakages, previous abdominal surgeries, and longer operating times were all correlated with postoperative SBO, but there were no differences in the incidence of SBO between laparoscopic vs. open surgery. The use of adhesion prevention material had no effect on SBO. Our data showed that the onset of SBO tended to be relatively early, within a year after surgery (89.5%)., Conclusions: Tumor localization in the rectum is associated with several problems, including a wide resection area, prolonged operative duration, and high risk of anastomotic leakage, which may increase the risk of SBO. Laparoscopic surgery and adhesion prevention material did not demonstrate a clear preventive effect against SBO., (© 2023. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Metabolic syndrome (MetS) is defined by the clustering of several associated with a group of disorders that include: obesity, dyslipidemia, hypertension, and insulin resistance. The incidence of MetS is increasing globally around the world. Indeed the rates of different types of surgery in older or younger patients with Mets are increasing and they are exposed to a wide range of operations including abdominal, pelvic, urologic, or any invasive procedures. Post-surgical adhesion is a common problem and is a challenge for the surgeon. Despite many studies on its pathogenesis, there remain many un-answered questions about it, for example why certain tissues and patients are more at higher risk of post-surgical adhesions. Many studies have suggested that MetS is associated with up-regulating molecular mechanisms leading to chronic inflammation and hypercoagulability. In this review, we discuss some of the molecular mechanisms by MetS may enhance post-surgical adhesion, and particularly regarding those involved in coagulation and inflammation.

Study Objective: To test the hypothesis that intraperitoneal instillation of a single bolus dose of l-alanyl-l-glutamine (AG) will reduce the incidence, extent and/or severity of adhesions following myomectomy and establish preliminary safety and tolerability of AG in humans., Design: Phase 1,2 Randomized, double-blind, placebo-controlled study (DBRCT)., Setting: Tertiary care gynecology surgical centre., Patients: Thirty-eight women who underwent myomectomies by laparoscopy (N = 38; AG-19 vs Placebo-19) or laparotomy (N = 10; AG-5 vs Placebo-5) with a scheduled second-look laparoscopy (SLL) 6-8 weeks later. Thirty-two patients in the laparoscopy arm completed SLL., Interventions: Bolus dose of AG or normal saline solution control (0.9% NaCl) administered intraperitoneally immediately prior to suture closure of the laparoscopic ports. The average dose was 170 mL of AG or control based on a dosing scheme of 1 g/kg bodyweight., Measurements: Digital recordings obtained for all procedures. The primary endpoint was reduction in the incidence, severity and extent of post-operative adhesions analyzed by intention-to-treat (ITT) approach. Three independent, blinded reviewers evaluated all operative video recordings to assess presence of adhesions. Post-hoc analysis assessed presence or absence of adhesions in the peritoneal cavity. Secondary endpoints assessed safety and tolerability of AG., Main Results: Administration of AG reduced the incidence, severity and/or extent of post-operative adhesions (p = 0.046). The presence of adhesions in the AG group was lower than in the Control group (p = 0.041). Adhesion improvement was achieved in 15 of 15 (100%) in the AG group versus 5 of 17 (29.6%) in the placebo group. No serious adverse events were reported. No differences in safety parameters were observed., Conclusions: Intraperitoneal l-alanyl-l-glutamine reduced adhesion formation in all patients following laparoscopic myomectomy. Complete absence of adhesions was achieved at all abdominal sites in 93% of patients. Results confirm AG's known effects on cellular mechanisms of adhesiogenesis and lay the foundation for new adhesion prophylaxis research and treatment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Context: Peritoneal adhesions unlike other immediately recognizable complications of the surgery may produce long-term consequences, which include infertility and intestinal obstruction., Aims: The study aimed to determine the prevalence, the determinants, and the outcomes of laparoscopic surgery associated with intraperitoneal adhesion findings., Settings and Design: This was a retrospective observational study., Materials and Methods: The study included all laparoscopic gynecological surgeries done between January 2017 and December 2021. Adhesion severity was graded, using the peritoneal adhesion index (PAI), by Coccolini et al., Statistical Analysis: The data were analyzed using the SPSS version 21.0. Binary logistic regression was used to assess the factors associated with adhesion finding during laparoscopy., Results: There were 158 laparoscopic surgeries with 26.6% prevalence of peritoneal adhesions. The prevalence of adhesions among women with previous surgery was 72.7%. Previous peritoneal surgery was a significant determinant of occurrence of adhesions (odds ratio = 8.291, 95% confidence interval [CI] = 4.464-15.397, P < 0.001), and such patients had significantly (P = 0.025, 95% CI = 0.408-5.704) more severe adhesions (PAI = 11.16 ± 3.94) than those without prior surgery (PAI = 8.10 ± 3.14). Abdominal myomectomy (PAI = 13.09 ± 2.95) was the most important primary surgical determinant of adhesion formation. There was no significant relationship between adhesion occurrence and conversion to laparotomy (P = 0.121) or mean duration of surgery (P = 0.962). Greater adhesion severity was, however, observed in individuals with operative blood loss <100 ml (PAI = 11.73 ± 3.56, P = 0.003) and those hospitalized for ≤2 days (PAI = 11.12 ± 3.81, P = 0.022)., Conclusion: The prevalence of postoperative adhesions during laparoscopy in our center is comparable to what has been earlier reported. Abdominal myomectomy is associated with the greatest risk and severity of adhesions. Laparoscopy in patients with more severe adhesions resulted in less blood loss and shorter duration of hospitalization, suggesting an association of better outcomes with a cautious approach to adhesions., Competing Interests: None

Objective: To evaluate the prevalence of intraperitoneal adhesions after repeated cesarean delivery and its associated personal and surgical risk factors., Methods: This prospective cohort study was conducted at the delivery ward at Fayoum University Hospital from October 2020 to December 2021. Women were recruited according to predetermined inclusion and exclusion criteria. Eligible women were interviewed, and data were obtained for personal history, past surgical and obstetrical history, and data about the current delivery. Nair's scoring system was used to evaluate intraperitoneal adhesions. Postoperative data and complications were reported., Results: Three hundred women were recruited. Moderate to severe adhesions occurred in 186 patients (62%). These patients had a significantly prolonged hospital stay and were delivered by expert surgeons (P < 0.001 and P = 0.008, respectively). The adhesion score correlated positively with patients' age (P < 0.001), parity (P < 0.001), interpregnancy interval (P = 0.033), duration of hospital admission either previously or in the current delivery (P = 0.001 and P < 0.001), time to ambulation (P < 0.001), time to intestinal movement (P < 0.001), operative time (P < 0.001), and surgeons' age and experience (both P = 0.015)., Conclusion: Adhesions led to increased maternal morbidity. Multiple contributing factors were significantly related to adhesions with multiple cesarean deliveries., (© 2022 International Federation of Gynecology and Obstetrics.)

Introduction: Small bowel obstruction (SBO) due to internal herniation (IH) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study is to evaluate different types of non-absorbable sutures used for closure of the defects regarding the incidence of SBO due to IH/adhesions, adhesion formation in general, or reopening of the defects., Methods: A single-center retrospective study was performed. Patients who underwent LRYGBP were divided in 3 groups: group A closure of the defects with monofilament Polypropylene suture (Prolene®), group B with braided polyester suture (Ethibond®), group C with barbed knotless Polybutester suture (V-Loc®). Descriptive statistics were performed regarding SBO due to IH/adhesions, adhesion formation, and reopening of closed defects., Results: From 5145 patients, 224 patients underwent exploratory laparoscopy for suspicion of SBO. Mean time interval was 28.4 months. IH or intermittent IH was found in 1.94% in group A, 1.78% in group B, and 1.40% in group C. Obstruction due to adhesions was found in 0.70%, 0.36%, and 0.42% per group, respectively. Adhesions in general were observed in 1.47% in group A, 1.43% in group B, and 1.06% in group C. The incidence of reopening was higher in group A (2.24%) in comparison with group B (1.13%, P = 0.041) and group C (1.05%, P = 0.001)., Conclusions: After descriptive analysis, these results can withhold no difference among the 3 non-absorbable sutures regarding incidence of SBO due to IH or SBO due to adhesions, yet tendency for higher reopening rates after closure with monofilament Polypropylene suture is observed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Moderate to severe intrauterine adhesions (IUAs) may greatly impact fertility, predisposing to pregnancy and obstetric complications. The impact of mild IUAs on reproductive performance remains unclear. A systematic review and meta-analysis was performed to examine the long-term reproductive outcomes in women with hysteroscopic identified and treated mild IUAs mild intrauterine adhesions (IUAs)., Methods: An electronic literature search was conducted using MEDLINE and EMBASE from inception to June 2019. All prospective cohort, cross-sectional studies or randomized controlled trials Clinical trials in which reproductive outcomes of women with mild IUAs, were reported were included., Results: Five studies, reporting on reproductive outcomes of 229 women with hysteroscopic identified and treated mild IUAs, were included. The pregnancy rate was 62.3% (142 of 228; 95% CI: 0.55-0.72, I 2 25%, p  = .21) and in 86.6% (123 of 142) a live birth was encountered (95% CI: 0.71-0.97) with 83.1% (108 out of 130) term deliveries (95% CI: 0.53-0.95). A miscarriage was reported in 10% (13 of 130; 95% CI: 0.02-0.26). Due to the lack of a control group, reproductive outcomes were compared to a general population. Pregnancy and live birth rates were significantly lower in women with identified and treated mild IUAs, 90% versus 62.3% and respectively 99.5% versus 86.6%. The miscarriage rate was similar. Data on obstetric and neonatal outcomes are lacking., Conclusions: Women with hysteroscopic identified and treated mild IUAs seem to have lower pregnancy and live birth rate compared to the general population. Future studies consisting of a large cohort of women with hysteroscopic identified and treated IUAs with structural follow-up and a control group are needed to confirm our findings.

Objective: To explore the impact of concomitant intrauterine adhesions (IUAs) on pregnancy outcomes and obstetric complications in women with a septate uterus., Methods: This retrospective cohort included women with a septate uterus, with or without IUAs, between 2015 and 2019 in our hospital. The main outcomes were clinical pregnancy rate, live-birth rate, and obstetric complications., Results: A total of 336 women with a septate uterus-105 women (31.3%) with IUAs and 231 (68.7%) women without IUAs-were analyzed. The rates of clinical pregnancy and live birth among women with moderate-to-severe IUAs were significantly decreased compared with those among women without IUAs (69.9% vs. 76.6%, odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27-0.99, P = 0.046, and 57.0% vs. 67.1%, OR 0.53; 95% CI 0.30-0.95, P = 0.032, respectively). However, these rates were similar between women with mild IUAs and women without IUAs. Women with moderate-to-severe IUAs had a higher incidence of abnormal placentation than women with a septum only (13.2% vs. 1.3%, P = 0.001)., Conclusion: Concomitant moderate-to-severe IUAs significantly reduce the rates of clinical pregnancy and live birth and increase the risk of abnormal placentation in subsequent pregnancies in women with a septate uterus., (© 2022 International Federation of Gynecology and Obstetrics.)

Background: Intraperitoneal adhesion is a common complication of cesarean section, and adhesion barriers are often used to prevent postoperative adhesion. However, the association between the use of adhesion barriers and infections after cesarean section remains unknown. This study aimed to evaluate the association., Methods: Using the administrative claims database of a single prefecture in Japan, we identified all patients who underwent cesarean section from June 2014 to February 2019. A multivariable logistic regression model fitted with a generalized estimating equation was used to compare the postoperative outcomes between patients who received intraperitoneal adhesion barriers during cesarean section and those who did not. The primary outcome was intraperitoneal or uterine infections within 3 months after cesarean section, including intraperitoneal abscess, pelvic inflammatory disease, peritonitis, uterine wound infection, endometritis, and adnexitis., Results: A total of 1,392 patients with 1,498 cesarean section cases were reviewed. Adhesion barriers were used in 1,153/1,498 (77.0%) cases. One hundred and fourteen (9.9%) intraperitoneal or uterine infections occurred in the group with and 15 (4.3%) in the group without adhesion barriers. The proportion of intraperitoneal or uterine infections was significantly higher in the group with than in the group without adhesion barriers (9.9% and 4.3%, respectively; adjusted odds ratio = 2.59; 95% confidence interval, 1.40-4.77; P = .002)., Conclusion: The use of adhesion barriers was associated with an increase in intraperitoneal or uterine infections after cesarean section., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The current study objectively identified the incidence of adhesions between the stomach and pancreas in laparoscopic sleeve gastrectomy (LSG) patients on liraglutide (cases group) and off (control group) liraglutide., Methods: This observational prospective study was conducted in the Department of General Surgery at Saudi German Hospital, Al-Aseer, Saudi Arabia (SGH) after approval by the Institutional Review Board. 117 patients with prior use of liraglutide and 101 patients with no liraglutide use scheduled for LSG over 12 months were included. Inclusion criteria included patients undergoing LSG with or without prior use of liraglutide. Exclusion criteria included patients with prior abdominal surgeries, bariatric surgery revisions, prior upper GI scope showing gastritis, Gastroesophageal Reflux Disease (GERD) or any other pathology, and other known causes of other causes of pancreatitis. Using laparoscopy obtained imaging during LSG cases adhesions between the posterior stomach and pancreas were identified., Results: The mean age of the patients in the cases and control groups was 32.44 ± 9.90 years and 28.23 ± 8.48 years (p = 0.001). The mean BMI of patients in the cases and control groups was 43.56 ± 4.59 and 45.00 ± 4.78, respectively (p = 0.024). 85% of the patients were females, while 17.0% were males in the cases group. 53.5% of the patients were females, while 47.0% were males in the control group (p < 0.001). In the cases group, 48.7% of patients had stopped liraglutide for no obvious reason. Under the cases group, 77.8% of the patients had no adhesions, while 22.2% had adhesions. Under the controls group, no adhesions were seen (p < 0.001)., Conclusions: Our results for the first time demonstrate an incidence of adhesions in 22.2% of patients undergoing LSG on prior liraglutide intake (p < 0.001). This study brings to light the possibility of adhesions in patients with prior exposure to liraglutide undergoing LSG. Surgeons performing LSG in patients with prior exposure to liraglutide should be cognizant of this possibility, thereby requiring careful meticulous dissection., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

To investigate the current status of uterine adhesions in patients with residual fetus and analyze the preventive effect of estrogen and progesterone sequential therapy combined with Foley balloon. Eighty-six patients with residual fetus were divided into control group and observation group. On the basis of the treatment plan of the control group, the observation group received estrogen and progesterone sequential therapy combined with Floey balloon treatment. Clinical efficacy, postoperative recovery status (abdominal pain duration, vaginal bleeding duration, vaginal bleeding volume, refluid time), the incidence of intrauterine adhesions, uterine hemodynamics (uterine artery systolic maximum blood flow rate [Vmax], end diastolic blood flow rate [Vmin], resistance index [RI]), and the probability of complications were evaluated. Compared with the control group, the observation group achieved higher curative effect (P < .05); the observation group had shorter duration of abdominal pain, vaginal bleeding and refluid time, and lower vaginal bleeding (P < .05); the probability of intrauterine adhesions is lower (P < .05); before treatment, there is little difference in the levels of Vmax, Vmin, RI, and other indicators between the 2 groups (P > .05). After treatment, compared with the control group, the observation group Vmax, Vmin, and other indicators, the level was significantly lower, and the RI level was significantly higher (P < .05); the observation group had a lower probability of complications (P < .05). The likelihood of uterine adhesions after fetal remains is increased. The use of estrogen and progesterone sequential therapy in conjunction with Foley balloon therapy can improve treatment efficacy, improve uterine adhesion prevention, and promote patient recovery after surgery., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Adhesions following abdominal surgery can cause small bowel obstruction (SBO) necessitating surgery. Whilst some studies have addressed SBO in children, the incidence of SBO, the diseases that are of increased risk as well as risk factors in young children remain unclear. Therefore, this study aims to determine; (1) the general incidence of SBO in young children, (2) which diseases entail highest incidence of SBO and (3) risk factors for SBO in young children., Study Design: Young children (≤ 3 years of age) who underwent abdominal surgery in our tertiary referral centre between 1998-2018 were retrospectively included. Both general incidence and incidence per disease of SBO were determined. Independent risk factors for SBO were identified using cox-regression., Results: The incidence of SBO was 5% (N = 88/1931) in our cohort. Five of the SBOs developed following laparoscopic treatment. Patients treated for gastroschisis (17%,N = 9/53), necrotizing enterocolitis (8%,N = 15/188) and intestinal atresia (7%,N = 13/177) were at high risk of experiencing SBO. Diaphragmatic hernia (28%,N = 7/25) and meconium ileus (28%,N = 7/25) also showed high SBO proportions. Having a history of stoma (HR:3.2, 95%-CI:2.0-5.2), undergoing emergency surgery (HR:2.2, 95%-CI:1.3-3.7) and postoperative infections (HR:1.9, 95%-CI:1.2-3.1) were general risk factors for the development of SBO., Conclusion: The incidence of SBO in young children seems higher than what has previously been reported in older children, which is why they should be studied separately. The incidence of SBO differs between diseases. Having a history of a stoma, emergency surgery and postoperative infections were independent risk factors for SBO development. Although less at risk, SBOs do develop after laparoscopies, which is why they should be included in more long-term follow-up studies., Level of Evidence: II., Competing Interests: Declaration of Competing Interest None to report, (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The aim of this study was to evaluate hysteroscopic findings after laparoscopic and laparotomic myomectomy with a focus on the presence of postoperative intrauterine adhesions in groups of patients with and without perioperative uterine cavity breach (UCB)., Material and Methods: This is a historical cohort study. Our database was searched to identify patients with UCB during myomectomy and matched the same number of patients after myomectomy without UCB to create a control group. All relevant data were retrieved from our medical records. In both groups, the results of follow-up hysteroscopy were analyzed., Results: Low prevalence of intrauterine adhesions after myomectomy was observed in only 3.5% of the 170 patients in our samples. No significant difference in the occurrence of synechiae between the patients with and without UCB was found (2 vs. 4, RR 0.5, 95% CI 0.1-2.7, p  = .341), nor was the difference in other hysteroscopic findings. Follow-up hysteroscopy was performed with slender optics and expandable casing system without need of any anesthesia in 87.1% of cases., Conclusions: According to our findings, the prevalence of post-myomectomy intrauterine adhesions after myomectomy is low. Our study did not demonstrate that UCB during myomectomy is a risk factor for the formation of intrauterine synechiae.

Objective: The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery., Methods: Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m 2 and ≥30 kg/m 2 ). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared., Results: Intra-abdominal adhesions were more common in women ≥30 kg/m 2 than in those <30 kg/m 2 (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m 2 vs. 30.5 ± 4.8 kg/m 2 , p  = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m 2 vs. 25.7 ± 5.2 kg/m 2 , p  = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m 2 than in those <30 kg/m 2 (39.6% vs. 23.7%, p  = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p  = .001) in women ≥30 kg/m 2 with intra-abdominal adhesions (16.7% vs. 35.4%, p  = .005)., Conclusion: Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.

Introduction: Adhesions are one of the common complications encountered after caesarean section whose risk increases with the number of caesarean deliveries. This study aimed to find out the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section in a tertiary care centre., Methods: A descriptive cross-sectional study was conducted on 74 pregnant women undergoing repeat caesarean section in the Department of Obstetrics and Gynaecology of a tertiary care centre from July, 2021 to December, 2021 after receiving the ethical approval from the Institutional Review Committee (Reference number: 2107202103). Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. The severity of the adhesions was classified using the Tulandi and Lyell classification. Data were analysed using the Statistical Package for the Social Sciences version 26.0 software. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data along with mean and standard deviation for continuous data., Results: Out of 74 women undergoing repeat caesarean section, 55 (74.32%) (65.99-82.65 at 90% Confidence Interval) had developed intra-abdominal adhesions., Conclusions: Our study showed that the prevalence of intra-abdominal adhesions among patients undergoing repeat caesarean section was higher when compared to similar studies conducted in similar settings., Keywords: postoperative complications; repeat caesarean section; surgical adhesions.

Research Question: What are the prevalence and risk factors of intrauterine adhesions (IUA) in patients with a septate uterus?, Design: In this retrospective cohort study, patients with a septate uterus who underwent septum resection between 2015 and 2020 were analysed. Two-dimensional transvaginal ultrasonography plus hysteroscopy was used to diagnose uterine septum or IUA. The prevalence and risk factors for IUA in patients with a septate uterus were examined., Results: Among 522 eligible patients with a septate uterus, 165 patients were diagnosed with IUA (prevalence 31.6% [95% CI 27.7 to 35.5%]). In the multivariable logistic regression analysis of risk factors for IUA, patients who had experienced one or more miscarriages were more likely to have IUA than patients who had not (OR 3.38, 95% CI 1.96 to 5.83, P < 0.001, and OR 2.55, 95% CI 1.24 to 5.23, P = 0.011, respectively). Patients who underwent one or more dilatation and curettage (D&C) procedures had a significantly increased risk of IUA compared with patients who did not (OR 3.42, 95% CI 1.87 to 6.26, P < 0.001, and OR 3.99, 95% CI 1.93 to 8.26, P < 0.001, respectively). For patients with a history of miscarriage or D&C, the prevalence rates of IUA were 46.5% (95% CI 40.6 to 52.4%) and 44.0% (95% CI 38.5 to 49.5%), respectively., Conclusion: Nearly one-third of patients with a septate uterus have concomitant IUA. A previous miscarriage or D&C is an important risk factor for IUA in patients with a septate uterus., (Copyright © 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: Colorectal surgery is associated with a high risk of adhesion formation and subsequent complications. Laparoscopic colorectal surgery reduces adhesion formation by 50%; however, the effect on adhesion-related complications is still unknown. This study aims to compare differences in incidence rates of adhesion-related readmissions after laparoscopic and open colorectal surgery., Method: Population data from the Scottish National Health Service were used to identify patients who underwent colorectal surgery between June 2009 and June 2011. Readmissions were registered until December 2017 and categorized as being either directly or possibly related to adhesions, or as reoperations potentially complicated by adhesions. The primary outcome measure was the difference in incidence of directly adhesion-related readmissions between the open and laparoscopic cohort., Results: Colorectal surgery was performed in 16 524 patients; 4455 (27%) underwent laparoscopic surgery. Patients undergoing laparoscopic surgery were readmitted less frequently for directly adhesion-related complications, 2.4% (95% CI 2.0%-2.8%) versus 7.5% (95% CI 7.1%-7.9%) in the open cohort. Readmissions for possibly adhesion-related complications were less frequent in the laparoscopic cohort, 16.8% (95% CI 15.6%-18.0%) versus 21.7% (95% CI 20.9%-22.5%), as well as reoperations potentially complicated by adhesions, 9.7% (95% CI 8.9%-10.5%) versus 16.9% (95% CI 16.3%-17.5%)., Conclusion: Overall, any adhesion-related readmissions occurred in over one in three patients after open colorectal surgery and one in four after laparoscopic colorectal surgery. Compared with open surgery, incidence rates of adhesion-related complications decrease but remain substantial after laparoscopic surgery., (© 2021 The Association of Coloproctology of Great Britain and Ireland.)

Objectives: The aim of this study was to evaluate intrauterine adhesion formation after laparoscopic and laparotomic myomectomy., Design: This is a prospective, multicenter, observational study (ClinicalTrials.gov ID: NCT04030273)., Methods: We included patients after laparotomic and laparoscopic myomectomy. All patients underwent postsurgical diagnostic hysteroscopy, after 3 months. The intrauterine adhesion rate and associated factors were investigated., Results: Between January 2020 and December 2020, 38 and 24 consecutive patients underwent laparoscopic and laparotomic myomectomy, respectively. All diagnostic hysteroscopies were performed in the office setting without complications. Intrauterine adhesions were identified in 19.4% of women (95% CI: of 9-29%). Factors univariately associated (p < 0.2) with the presence of intrauterine adhesions after myomectomy were previous uterine surgery, the surgical approach (laparoscopic or laparotomic), the number of removed fibroids, the type and diameter of the largest myoma, and the opening of the uterine cavity. In the multivariable analysis, only the opening of the uterine cavity (odds ratio [OR] 51.99; 95% confidence interval [CI]: 4.53-596.28) and the laparotomic approach (OR, 16.19; 95% CI: 1.66-158.35) were independently associated with the identification of intrauterine adhesions after myomectomy., Limitations: One of the main limitations of our study is that we used uterine manipulator only in the laparoscopic group; in addition, we did not perform a preoperative hysteroscopy to evaluate the rate of intrauterine adhesions potentially present even before the myomectomy., Conclusions: The prevalence of intrauterine adhesions after 3 months from surgery was significantly associated with the opening of the uterine cavity and the laparotomic approach., (© 2022 S. Karger AG, Basel.)

Purpose: To assess the prevalence of vitreomacular adhesion (VMA) in consecutive naïve eyes diagnosed with macular oedema (ME) secondary to retinal vein occlusion (RVO) and to longitudinally evaluate the incidence of vitreomacular interface changes over time and the influence on response to treatment., Design: Retrospective cross-sectional analysis and longitudinal cohort study conducted at two Italian tertiary referral centres., Methods: A total of 295 eyes, treated with intravitreal ranibizumab and/or dexamethasone for ME secondary to RVO between June 2008 and May 2018, were enrolled in the study. 280 fellow eyes met the inclusion criteria and were included as control group. The vitreomacular interface status was evaluated by spectral domain optical coherence tomography (OCT) and graded according to the OCT-based International Classification System developed by the International Vitreomacular Traction Study (IVTS) group., Results: At baseline, VMA was present in 130 (44.07%) RVO eyes and 142 (50.7%) control eyes (no statistically significant difference was found; p = 0.455). Mean follow-up (FU) was 35.98 months (min 6 - max 112). Throughout the FU, the incidence of spontaneous release of VMA (RVMA) in RVO eyes was significantly higher in comparison with that of the control group [59 (41.84%) RVO eyes versus 18 (12.33%) control eyes; p < 0.0001]. The number of injections in VMA+ eyes was significantly higher when compared with VMA- eyes. No significant difference was found between VMA+ and VMA- eyes regarding their mean best-corrected visual acuity (BCVA) at baseline and at each annual time point (p = 0.2). Differences in central macular thickness (CMT) were significant only at the baseline evaluation (p = 0.0303)., Conclusions: Vitreomacular adhesion (VMA) was not found to be more prevalent in eyes with RVO compared to healthy fellow eyes, and RVO, in turn, did not result in a higher persistence of VMA over time. This suggests that VMA and RVO might be two independent retinal phenomena, with no mutual pathogenetic influence. Vitreomacular adhesion (VMA) might have an impact on the response to treatment, since it was found to result in a more intensive treatment regimen; however, it did not affect visual and anatomic outcomes. These results do not support vitrectomy or PVD induction in the prevention, nor the treatment, of RVO., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Introduction: Labial adhesions (LA) involves fusion of the labia minora in the midline. LA can range from involving just a small portion of the labia minora or the entire length, covering the urethra and vaginal opening. Treatment for labial adhesions includes the use of topical creams, manual lysis or surgical separation. The recurrence rate has been reported as 55%, 33% and 0% respectively. Only one study with a cohort of 9 patients examines recurrence rates after surgical release (0%)., Objective: To verify the previous findings that surgical repair has low recurrence rate. We hypothesize the recurrence rate of LA after surgical repair to be lower than more conservative methods but that the recurrence rate is not 0%., Study Design: A retrospective review was performed of consecutive cases of LA that were treated surgically from August 2018 to October 2020. The surgical technique used involved opening the LA bluntly then oversewing each labia with fine absorbable suture. All patients were scheduled for clinic or telephone follow up 3 months postoperatively. Patient demographics, indication for procedure, history of prior treatment, operative time, complications, recurrence and length of follow up were recorded and are described using non-parametric methods., Results: Thirty-two female patients underwent surgical treatment of LA using the above-described technique. Median age at surgery was 3.7 y (IQR 2.7-5.3). Most patients (78.1%) had failed prior initial treatment, most commonly topical estrogen creams. Median follow up was 4.3 mos with 10 patients being lost to follow up. Only 2 patients experienced a recurrence at a median of 3.5 months., Conclusions: This series verifies prior findings that, in the short-term, surgical repair has a lower recurrence rate than topical treatment or manual lysis. However, the recurrence rate is 9%, higher than previously reported. Further studies into longer-term follow up are underway., Competing Interests: Conflict of Interest None., (Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Adhesive small bowel obstruction (ASBO) is one of the major causes of postoperative morbidity. Non-surgical management is generally applied to non-strangulated ASBO. Several factors have been reported to affect the response to non-surgical management in patients with ASBO. However, the association between sex differences and non-strangulated ASBO remains unclear. This study aimed to elucidate the effect of sex differences in non-strangulated postoperative ASBO., Methods: We divided 139 patients with a first episode of non-strangulated postoperative ASBO into two groups: male group (n = 83) and female group (n = 56). Clinical features and prognosis were compared between the two groups., Results: Female patients had lower proportions of oesophageal/gastric malignancies (P = 0.044) and colorectal malignancies (P = 0.030) and a higher proportion of uterine/ovarian malignancies (P < 0.001) than male patients did. More female patients required surgical management than male patients (P = 0.003) did. Hospital length of stay (LOS) was longer (P = 0.046) in the female group than in the male group. Multiple logistic regression analysis showed that the female sex was associated with an increased risk of the need for surgical management (odds ratio 5.318, P = 0.006). Cox proportional hazards regression analysis revealed that the female sex was positively associated with increased LOS (hazard ratio 0.687, P = 0.045)., Conclusion: Female sex was associated with failure of non-surgical management and increased LOS in patients with non-strangulated postoperative ASBO., (© 2021 Royal Australasian College of Surgeons.)

Abstract: To compare the patients' outcomes of Asherman syndrome who underwent uterine adhesiolysis in luteal phase or follicular phase.A retrospective cohort study.A tertiary hospital in China.Four hundred sixty-four women suffered intrauterine adhesion who underwent monopolar adhesiolysis from March 2014 to March 2017 were analyzed. One hundred seventy-eight patients underwent operations in follicular phase (OFP) and 286 underwent operations in luteal phase (OLP).Hormone therapy was accompanied with an intrauterine device and a second-look hysteroscopy was performed postoperatively.Endometrial thickness in women was analyzed by a transvaginal 3-dimensional ultrasound examination. Re-adhesion was confirmed by a second-look hysteroscopy 3 months after hysteroscopic adhesiolysis. Pregnancy rate was acquired by questionnaires 3 months after a second-look hysteroscopy.OLP has advantages with thicker luteal endometrium (P = .001), higher pregnancy rates (P < .001), and lower re-adhesion rates (P = 0015) compared to these values of OFP.For Asherman syndrome, our study showed that OLP is more feasible than OFP in intrauterine adhesiolysis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: The effectiveness of using anti-adhesion agents in laparoscopic surgery is controversial. We compared the outcomes of patients exposed to anti-adhesion agents (barrier group) with those of patients not exposed (no barrier group) in laparoscopic surgery., Methods: Using a nationwide claim-based database in Japan, we analyzed data from patients who underwent laparoscopic surgery between 2005 and 2019 and compared the patient characteristics and the proportion of those with bowel obstruction between the barrier and no barrier groups. We also performed several sensitivity and subgroup analyses., Results: Of the 57,499 patients who met the inclusion criteria, 14,360 and 43,139 were assigned to the barrier and no barrier groups, respectively. The proportion of patients with a bowel obstruction in the two groups did not differ among all patients hospitalized for obstruction (1.1 vs. 1.1%, p = 0.63) and those requiring surgery (0.2 vs. 0.2%, p = 0.39). In the sensitivity analysis with propensity score matching, the incidences of bowel obstruction between the barrier and non-barrier groups were equivocal (1.3 vs. 1.6%), but statistically marginal (chi-square test, p = 0.035; log-rank test, p = 0.09)., Conclusion: The use of barrier agents for adhesive prevention did not show clear effectiveness for the prevention of bowel obstruction after laparoscopic surgery for unselected cases. Further studies focusing on more specific procedures are needed., (© 2021. Springer Nature Singapore Pte Ltd.)

Introduction: A dura mater substitute in decompressive craniectomies must protect the brain while providing a dissection plane between the cortex and myocutaneous layer. The human amniotic membrane (AM) has anti-inflammatory, wound healing, and differentiation properties. We tested AM properties as a dural substitute by comparing the outcomes to biological ones., Methods: We prospectively collected data on 25 patients who randomly underwent decompressive craniectomy with lyophilized AM patches and 25 in which biological substitutes were utilized between 2015 and 2019. The AM was laid with the epithelial side facing the brain because of the anti-adhesive proprieties, while the chorion facing the myocutaneous flap. We collected data on demographics, neurological status, comorbidities, and surgical outcomes. Additionally, we created a score - dura mimicking score- and reviewed postoperative imaging and pathological specimens., Results: The majority (96%) of AM grafts were integrated into native dura. Thirteen patients scored as excellent and 11 good on our "dura mimicking score", showing tissue integration ability but no cerebral cortex adhesion. The histopathological analysis showed that AM had thick plates of dense fibrous tissue with small reactive vessels, reactive fibroblasts, and lymphocytes infiltrate. The AM group's first outcomes were not different from the biological substitute patients but higher integration rate to the dura and less adhesion to the myocutaneous flap in AM patients., Conclusions: We documented the anti-adhesive, protective, and integrative properties of AM dural substitute patches in patients who underwent decompressive craniectomies, comparing the intraoperative differences and postoperative outcomes to biological dural substitutes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Chronic pelvic pain affects approximately 15% of reproductive age women. It is mainly caused by adhesions (20-40%). Despite CPP being the main symptom of endometriosis, the disease is confirmed by laparoscopy only in 12-18% of cases. The aim of this study was to evaluate the results of laparoscopy in women with CCP and to assess the sensitivity and specificity of elements of an interview and clinical examination., Materials and Methods: The study included 148 women with CPP. Each patient underwent laparoscopy. In laparoscopy, the presence of endometriosis and/or peritoneal adhesions was confirmed. Then, the sensitivity and specificity and the positive and negative predictive value of endometriosis symptoms or abnormalities in the gynecological examination were statistically calculated., Results: After previous surgery, adhesions were found in almost half (47%) of patients. In patients without a history of surgery, adhesions were diagnosed in 6.34% of patients. Endometriosis without coexisting adhesions was more often diagnosed in women without previous surgery (34.9%), compared to 10.58% in the group with a history of surgery ( p < 0.05)., Conclusions: Intraperitoneal adhesions are most common in women after pelvic surgery and with chronic ailments. The best results for sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of endometriosis are found in women with irregular menstruations during which the pain increases. Laparoscopy still remains the primary diagnostic and therapeutic method for these women.

Introduction: This study aimed to assess the feasibility and efficacy of office hysteroscopy to diagnose and treat the specific uterine pathologies frequently diagnosed and thought to be associated with female infertility., Material and Methods: Using office hysteroscopy, we examined the uterine cavity in women with primary or secondary infertility and evaluated the reproductive outcomes of those affected by one or more pathologies, including cervico-isthmic adhesions, intrauterine polyps and intrauterine adhesions. Additional patient characteristics considered were age and parity, uterine pathology, pain during hysteroscopy, and outcomes including spontaneous pregnancies achieved and time between treatment and pregnancy., Results: Reproductive outcomes of 200 patients affected by one or more uterine pathologies were evaluated. Cervico-isthmic adhesions were the most frequent findings in older women, with nearly 80% of them achieving pregnancy sooner than the others in our study. Spontaneous pregnancy rates following office hysteroscopy were 76%, 53% and 22% in women with cervico-isthmic adhesions, polyps (< 5 mm) and intrauterine adhesions, respectively., Conclusions: Office hysteroscopy is a feasible and highly effective diagnostic and therapeutic procedure for cervico-isthmic and intrauterine adhesions, as well as for small polyps, allowing the resolution of female infertility related to these pathologies, without trauma and with only minimal discomfort.

Introduction: Pericardial access for ablation of ventricular arrhythmias (VA) can be gained either by an anterior-oriented or inferior-oriented epicardial puncture under fluoroscopical guidance. We retrospectively sought to assess the safety of these two puncture techniques and the incidence of epicardial adhesions and introduce our algorithm for management of pericardial tamponade., Methods and Results: In 211 patients (61.4 ± 15.6 years, 179 males; 84.8%) 271 epicardial ablation procedures of VA were performed using either an anterior- or inferior-oriented approach for epicardial access. Puncture-related complications were systematically analyzed. Furthermore, the incidence of adhesions was evaluated during first and repeated procedures. A total of 34/271 (12.5%) major complications occurred and 23/271 (8.5%) were directly related to epicardial puncture. The incidence of puncture-related major complications in the anterior and inferior group was 4/82 (4.9%) and 19/189 (10.1%), respectively. Pericardial tamponade was the most common major complication (15/271; 5.5%). Collateral damages of adjacent structures such as liver, colon, gastric vessels and coronary arteries occurred in 6/189 (3.2%) patients and only within the inferior epicardial access group. Adhesions were documented in 19/211 (9%) patients during the first procedure and in 47.1% if patients had 2 or more procedures involving epicardial access., Conclusion: Anterior-oriented epicardial puncture shows an observed association to a reduced incidence of pericardial tamponades and overall puncture-related complications in epicardial ablation of VA. In cases of repeated epicardial access adhesions increase significantly and may lead to ablation failure.

Background: Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery., Methods: An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity., Results: Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91-0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors., Conclusion: The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice.

Background: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions., Methods: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions., Results: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001)., Conclusion: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.

Importance: Adhesion-related complications (ARCs), including small-bowel obstruction, are common complications of intra-abdominal surgery. Statins, which have antifibrotic pleiotropic effects, inhibit adhesion formation in murine models but have not been assessed in humans., Objective: To assess whether statin use at the time of intra-abdominal surgery is associated with a reduction in ARCs., Design, Setting, and Participants: These 2 separate retrospective cohort studies (The Health Improvement Network [THIN] and Optum's Clinformatics Data Mart [Optum]) compared adults receiving statins with those not receiving statins at the time of intra-abdominal surgery. Individuals undergoing intra-abdominal surgery from January 1, 1996, to December 31, 2013, in the United Kingdom and from January 1, 2000, to December 31, 2016, in the US were included in the study. Those with obstructive events before surgery or a history of inflammatory bowel disease were excluded. Data analysis was performed from September 1, 2012, to November 24, 2020., Exposure: The primary exposure was statin use at the time of surgery., Main Outcomes and Measures: The primary outcome was ARCs, defined as small-bowel obstruction or need for adhesiolysis, occurring after surgery. Sensitivity analyses included statin use preceding but not concurrent with surgery, fibrate use, and angiotensin-converting enzyme inhibitor use. All analyses were adjusted for age, sex, and conditions associated with microvascular disease, such as hypertension, hyperlipidemia, obesity, and tobacco use; surgical approach and site; and diagnosis of a malignant tumor., Results: A total of 148 601 individuals met the inclusion criteria for THIN (mean [SD] age, 49.6 [17.7] years; 70.1% female) and 1 188 217 for Optum (mean [SD] age, 48.2 [16.4] years; 72.6% female). A total of 2060 participants (1.4%) experienced an ARC in THIN and 54 136 (4.6%) in Optum. Statin use at the time of surgery was associated with decreased risk of ARCs (THIN: adjusted hazard ratio [HR], 0.81; 95% CI, 0.71-0.92; Optum: adjusted HR, 0.92; 95% CI, 0.90-0.95). Similar associations were appreciated between statins and small-bowel obstruction (THIN: adjusted HR, 0.80; 95% CI, 0.70-0.92; Optum: adjusted HR, 0.88; 95% CI, 0.85-0.91)., Conclusions and Relevance: This study's findings suggest that, among individuals in 2 separate cohorts undergoing intra-abdominal surgery, statin use may be associated with a reduced risk of postoperative ARCs. Statins may represent an inexpensive, well-tolerated pharmacologic option for preventing ARCs.

Objective: The aim of this study was to assess the predictive value of five different intrauterine adhesion (IUA) evaluation systems for live birth rate following transcervical resection of adhesion (TCRA)., Method: This retrospective study included 128 women with IUA who desired for spontaneous conception after TCRA. All the patients were retrospectively scored by the American Fertility Society (AFS) classification, European Society of Gynecological Endoscopy (ESGE) classification, March's classification (March), Nasr classification (Nasr) and Chinese IUA diagnosis classification criteria (Chinese). The predictive value of these evaluation systems was determined by receiver operating characteristic (ROC) curves and area under a ROC curve (AUC)., Results: The correlation coefficients of AFS, ESGE, March, Nasr and Chinese classification and the live birth rate were 0.313, 0.313, 0.288, 0.380, and 0.336, respectively. Among women with hypomenorrhea and amenorrhea, as well as women with no infertility, the severities determined by all five evaluation systems were correlated with live birth rate (P <  0.001). All five scoring systems were efficient to predict live birth rate. Among them, Nasr classification showed the highest AUC (0.748) with the best predictive value. Multivariate logistic regression analyses showed that Nasr classification had the highest OR (OR, 6.523; 95% CI, 2.612, 18.263). And, Nasr's classification system also showed highest sensitivity (81.8%) and negative predictive value (96.7%) when divide the system into mild IUA vs. moderate and severe IUA., Conclusion: AFS, ESGE, March, Nasr and Chinese classification were demonstrated to be capable of predicting live birth following TCRA although the predictive capacities might be limited, and Nasr classification showed the highest predictive value of live birth.

Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80% with a mortality rate of 5,1 to 8,4% in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20% (17) to 33% (35) and to reduce the incidence of postoperative complications from 60,2% (41) to 25,3% (18), p<0,01, and the mortality rate from 23,5% (16) to 7% (5), p<0,05.

Objectives: To determine the utility of Second-look endoscopy with debridement (SLED) after functional endoscopic sinus surgery (ESS) in pediatric cystic fibrosis (CF) patients. To compare outcomes in pediatric CF patients undergoing sinus surgery for chronic sinusitis with or without SLED. To describe findings present at the time of SLED., Methods: Retrospective chart review of 61 ESS procedures performed at a tertiary care pediatric center from 2013 to 2016. Data collected included demographics, SLED findings, and 6-month pre-/postoperative disease specific outcomes including incidence of sinonasal and pulmonary exacerbations and revisions., Results: Sixty-one cases were reviewed. SLED was performed in 38 cases on average 22.4 days postoperatively. Average preoperative Lund-Mackay score was 14.9 and 14.8 among patients undergoing ESS with and without SLED, respectively. Pre-/postoperative intranasal steroid use and extent of surgery performed was similar among all patients. At the time of SLED, rates of synechiae, polyps and maxillary antrostomy obstruction were 26.3%, 23.7%, and 7.9%, respectively. The incidence and number of days to onset of postoperative sinonasal exacerbations requiring antibiotic therapy within 6 months of ESS were 1.0 (SD 1.0) and 85 days (SD 45.7); and 1.3 (SD 1.0) and 80.4 days (SD 40.5) for patients undergoing ESS with and without SLED, respectively ( P value .33). The number of days to first pulmonary exacerbation was 113.9 (SD 45.5) and 47.4 (SD 34.1) among SLED and non-SLED patients, respectively ( P value .01). No significant difference was observed in revision rates and time to revision ESS (30% and overall average 1.4 years, respectively)., Conclusion: The utility of SLED among pediatric CF patients remains unclear. While debridement did not have a significant impact on sinonasal exacerbations or revision rates, pulmonary exacerbations for patients undergoing SLED were delayed. Further studies are needed to clarify the impact of SLED.

Background: Adhesion barriers are increasingly used in hepatobiliary surgery. However, there has been no solid evidence yet in support of their safety., Methods: Incidences of global postoperative morbidities and major abdominal morbidities were compared between 101 consecutive patients who received a sheet-type adhesion barrier (Interceed ® ) and 134 patients who did not receive any adhesion barriers during hepatectomy. Propensity score (PS) adjustment was used to account for potential bias to receive Interceed., Results: In the PS-adjusted population, the incidences of both global postoperative morbidities and major abdominal morbidities showed no significant difference between the Interceed group and the control group (17.9% vs. 17.6%; P = 0.948 and 7.8% vs. 9.1%; P = 0.813, respectively). Multivariate analysis showed that age + 10 years (odds ratio [OR], 1.70; 95% CI, 1.15-2.50; P = 0.007), estimated blood loss + 100 mL (OR, 1.05; 95% CI, 1.01-1.09, P = 0.009), and laparoscopic approach (OR, 0.10; 95% CI, 0.01-0.75; P = 0.026) were independent predictors for global postoperative morbidities and operation time + 1 h (OR, 1.56; 95% CI, 1.23-1.96; P < 0.001) was a risk factor for major abdominal morbidity, while no specific association between the use of Interceed and the risk of postoperative morbidity was observed., Conclusions: Use of Interceed does not increase the risk of postoperative morbidities after hepatectomy.

Background: The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO., Methods: Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression., Results: Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively., Conclusions: The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach., Level of Evidence: Level III., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions., Methods: A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012., Results: Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1 st CS, 80 2 nd CS, 36 3 rd CS, 12 4 th and one 5 th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2 nd CSs, adhesions were not associated with closure of the peritoneum at 1 st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%)., Conclusions: Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1 st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.

Background: Whether prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) offers long-term survival benefit to patients with low-grade appendiceal mucinous neoplasms (LAMNs) after resection surgery is still under heated debate. The aim of the present meta-analysis is to investigate the comparative effectiveness and safety of prophylactic HIPEC regimens in LAMNs METHODS:: A systematic search of MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and controlledtrials.com will be performed. All published RCTs and quasi-RCTs through July 20, 2020 with language restricted in English will be included in this review study. Two reviewers will independently conduct the procedures of study identification, data collection, and methodological quality assessment. The primary outcomes are overall survival (OS) and disease-free survival (DFS). The secondary outcomes consist of peritonitis and sepsis, colonic fistula, chemotherapy-associated adverse events, and adhesive intestinal obstruction. The pooled odds ratios (ORs) or hazard ratios (HRs) and relative 95% confident intervals (CIs) of each outcome measurement will be calculated. EndNote X9 software will be applied to manage all citations. The Stata software version 14.0 and R x64 software version 3.5.1 will be employed for main statistical analyses., Discussion: This study will employ a network meta-analysis to summarize direct and indirect evidence in the specific area to provide detailed individualized guidance on surgical management for LAMNs., Registration: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 July 2020 (registration number INPLASY202070112).

Objective: Meningioma is an extra-axial tumor that forms adhesions toward the brain surface in the course of its growth. Predicting adhesions between the tumor and the brain surface leads to better predictions of surgical results. There are few studies on brain-tumor adhesions or postoperative hemorrhage. This study aimed to assess tumor vascularity of the dura and cerebral surface, and predict surgical outcomes using four-dimensional computed tomography angiography (4D CTA)., Patients and Methods: Using a dynamic contrast CT, we conducted a retrospective study of 27 patients with convexity (n = 15), falx (n = 6), and parasagittal (n = 6) meningiomas treated in our hospital from January 2016 to September 2018. We set the region of interest on the dural layer and cerebral surface side of meningiomas and calculated the mean CT value in each region. Distribution of blood flow in the tumor was classified into two groups: A, which has a higher CT value of the dural side than that of the brain surface side at every timing, and B, which meets the criteria other than those in group A. Demographic data, preoperative characteristic images, and postoperative complications were compared between the groups., Results: Twelve and 15 patients were classified into groups A and B, respectively. The extent of adhesions against the cerebral cortex in group A was significantly less severe compared with that in group B (p = 0.038). The rate of postoperative hemorrhage occurrence in group B (53%) was significantly higher than that in group A (8%) (p = 0.04). There were no significant differences in the other preoperative characteristic images or perioperative parameters between groups A and B., Conclusion: A 320-row dynamic contrast CT scanner can detect meningiomas with a high probability of severe adhesion toward the brain surface and postoperative intraparenchymal hematoma.

Background: Analyse admissions to Royal Perth Hospital (RPH) with acute small bowel obstruction (SBO), and identify trends between outcomes and management., Methods: Retrospective, single-centre review of patients admitted to RPH with acute SBO, between May 2017 and May 2018., Results: A total of 251 admissions met inclusion criteria. Increasing age correlated with increasing total length of stay (LOS) (r = 0.134, P = 0.033) and post-operative LOS (r = 0.349, P < 0.0001). Increasing age led to poorer outcomes (P < 0.0001). Diagnoses were most commonly adhesions (167/251 = 66.5%), hernias (47/251 = 18.7%) and inflammatory bowel diseases (11/251 = 4.4%). Operation rate for adhesional SBO was 24.6% (41/167) and non-adhesional SBO 54.8% (46/84). Median total LOS for operative versus conservative management was 9 days (interquartile range (IQR) 8) versus 3 days (IQR 3) (P < 0.0001). Median time to surgery was 1 day (IQR 2). Increased time from admission to theatre led to increasing post-operative LOS (r = 0.398, P = 0.0013). Median post-operative LOS for bowel resection versus no resection was 9 days (IQR 4.5) versus 6 days (IQR 4) (P = 0.0128). Of 101, 81 (80.2%) adhesional SBO resolved non-operatively after receiving Gastrografin, compared to 45 of 66 (68.2%) of those who did not (P = 0.07). It did not significantly alter total or post-operative LOS (P = 0.65 and P = 0.96), patient outcome (P = 0.26), or need for bowel resection (P = 0.63)., Conclusions: Operative management, bowel resection, older age and increasing time from admission to surgery increase LOS. Trial of Gastrografin in non-operative management of adhesion type small bowel obstructions does not significantly affect outcomes but tends to reduce operative rates., (© 2020 Royal Australasian College of Surgeons.)

Objective: To investigate the rates of intrauterine adhesion following hysteroscopy for removal of RPOC associated with surgical termination of pregnancy., Methods: We conducted a retrospective cohort study of all cases of removal by hysteroscopy of RPOC associated with surgical termination of pregnancy carried out at the Yitzhak Shamir (Assaf Harofe) Medical Center from January 2013 to December 2018. The rates of postoperative intrauterine adhesion were assessed by follow-up hysteroscopy., Results: Our study involved 85 cases of removal by hysteroscopy of RPOC associated with surgical termination of pregnancy. The mean size of the RPOC was 1.9 ± 0.9 cm, and the mean time from termination of pregnancy to hysteroscopy was 1.5 ± 0.9 months. Two patients (2.4%) were readmitted for postoperative complications (fever). Postoperative follow-up information was available for 49 cases (57.6%). A total of 47 of these women had a normal uterine cavity (95.9%) while 2 women (4.1%) were diagnosed with mild intrauterine adhesions., Conclusions: Hysteroscopy for removal of RPOC following surgical termination of pregnancy is associated with low rates of postoperative intrauterine adhesions. Additional studies may determine whether this is the procedure of choice in these cases., (Copyright © 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Background: Adhesions are fibrin bands that are a common consequence of gynaecological surgery. They are caused by conditions that include pelvic inflammatory disease and endometriosis. Adhesions are associated with comorbidities, including pelvic pain, subfertility, and small bowel obstruction. Adhesions also increase the likelihood of further surgery, causing distress and unnecessary expenses. Strategies to prevent adhesion formation include the use of fluid (also called hydroflotation) and gel agents, which aim to prevent healing tissues from touching one another, or drugs, aimed to change an aspect of the healing process, to make adhesions less likely to form., Objectives: To evaluate the effectiveness and safety of fluid and pharmacological agents on rates of pain, live births, and adhesion prevention in women undergoing gynaecological surgery., Search Methods: We searched: the Cochrane Gynaecology and Fertility Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and Epistemonikos to 22 August 2019. We also checked the reference lists of relevant papers and contacted experts in the field., Selection Criteria: Randomised controlled trials investigating the use of fluid (including gel) and pharmacological agents to prevent adhesions after gynaecological surgery., Data Collection and Analysis: We used standard methodological procedures recommended by Cochrane. We assessed the overall quality of the evidence using GRADE methods. Outcomes of interest were pelvic pain; live birth rates; incidence of, mean, and changes in adhesion scores at second look-laparoscopy (SLL); clinical pregnancy, miscarriage, and ectopic pregnancy rates; quality of life at SLL; and adverse events., Main Results: We included 32 trials (3492 women), and excluded 11. We were unable to include data from nine studies in the statistical analyses, but the findings of these studies were broadly in keeping with the findings of the meta-analyses. Hydroflotation agents versus no hydroflotation agents (10 RCTs) We are uncertain whether hydroflotation agents affected pelvic pain (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.52 to 2.09; one study, 226 women; very low-quality evidence). It is unclear whether hydroflotation agents affected live birth rates (OR 0.67, 95% CI 0.29 to 1.58; two studies, 208 women; low-quality evidence) compared with no treatment. Hydroflotation agents reduced the incidence of adhesions at SLL when compared with no treatment (OR 0.34, 95% CI 0.22 to 0.55, four studies, 566 women; high-quality evidence). The evidence suggests that in women with an 84% chance of having adhesions at SLL with no treatment, using hydroflotation agents would result in 54% to 75% having adhesions. Hydroflotation agents probably made little or no difference to mean adhesion score at SLL (standardised mean difference (SMD) -0.06, 95% CI -0.20 to 0.09; four studies, 722 women; moderate-quality evidence). It is unclear whether hydroflotation agents affected clinical pregnancy rate (OR 0.64, 95% CI 0.36 to 1.14; three studies, 310 women; moderate-quality evidence) compared with no treatment. This suggests that in women with a 26% chance of clinical pregnancy with no treatment, using hydroflotation agents would result in a clinical pregnancy rate of 11% to 28%. No studies reported any adverse events attributable to the intervention. Gel agents versus no treatment (12 RCTs) No studies in this comparison reported pelvic pain or live birth rate. Gel agents reduced the incidence of adhesions at SLL compared with no treatment (OR 0.26, 95% CI 0.12 to 0.57; five studies, 147 women; high-quality evidence). This suggests that in women with an 84% chance of having adhesions at SLL with no treatment, the use of gel agents would result in 39% to 75% having adhesions. It is unclear whether gel agents affected mean adhesion scores at SLL (SMD -0.50, 95% CI -1.09 to 0.09; four studies, 159 women; moderate-quality evidence), or clinical pregnancy rate (OR 0.20, 95% CI 0.02 to 2.02; one study, 30 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Gel agents versus hydroflotation agents when used as an instillant (3 RCTs) No studies in this comparison reported pelvic pain, live birth rate or clinical pregnancy rate. Gel agents probably reduce the incidence of adhesions at SLL when compared with hydroflotation agents (OR 0.50, 95% CI 0.31 to 0.83; three studies, 538 women; moderate-quality evidence). This suggests that in women with a 46% chance of having adhesions at SLL with a hydroflotation agent, the use of gel agents would result in 21% to 41% having adhesions. We are uncertain whether gel agents improved mean adhesion scores at SLL when compared with hydroflotation agents (MD -0.79, 95% CI -0.82 to -0.76; one study, 77 women; very low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Steroids (any route) versus no steroids (4 RCTs) No studies in this comparison reported pelvic pain, incidence of adhesions at SLL or mean adhesion score at SLL. It is unclear whether steroids affected live birth rates compared with no steroids (OR 0.65, 95% CI 0.26 to 1.62; two studies, 223 women; low-quality evidence), or clinical pregnancy rates (OR 1.01, 95% CI 0.66 to 1.55; three studies, 410 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention., Authors' Conclusions: Gels and hydroflotation agents appear to be effective adhesion prevention agents for use during gynaecological surgery, but we found no evidence indicating that they improve fertility outcomes or pelvic pain, and further research is required in this area. It is also worth noting that for some comparisons, wide confidence intervals crossing the line of no effect meant that clinical harm as a result of interventions could not be excluded. Future studies should measure outcomes in a uniform manner, using the modified American Fertility Society score. Statistical findings should be reported in full. No studies reported any adverse events attributable to intervention., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: Female genital tuberculosis (FGTB) is a form of extra pulmonary tuberculosis (EPTB) affecting women of reproductive age group. It causes significant morbidity in women especially infertility particularly in developing countries. Diagnosis is by endometrial sampling for acid fast bacilli (AFB) microscopy, culture, gene Xpert, polymerase chain reaction (PCR), histopathological evidence of epithelioid granuloma and by laparoscopic findings suggestive of tuberculosis., Aim: Present study was conducted to observe the prevalence of a new "Sharma's Sigmoid colonic adhesive band "in FGTB on laparoscopy., Methods: It was a prospective study in a tertiary referral center as a part of our ongoing tuberculosis project on 148 infertile women found to have FGTB on microbiological or laparoscopic findings over previous 10 years. A new laparoscopic "Sharma's Sigmoid colonic adhesive band" was looked for in these cases on laparoscopy., Results: The mean age, parity and duration of infertility and incidence of poor socioeconomic status was 26.9 years, 0.49, 5.3 years and 65.54% respectively. All patients had infertility with 83.78% primary and 16.22% secondary infertility while menstrual dysfuction especially hypomenorrhoea (31.75%), oligomenorrhoea (32.48%) were seen in respective cases. Constitutional symptoms like pyrexia (21.62%), weight loss (31.75%) appetite loss (33.5%) and abdominal pain (11.48%) and pelvic pain (27.70%) or abdominal mass (8.78%) and pelvic masses (35.81%) were also seen. Diagnosis of FGTB was made on endometrial or peritoneal biopsy microscopy or culture for AFB or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma or on laparoscopic findings of FGTB. Various laparoscopic findings were tubercles on pelvic organs (45.27%), shaggy areas (white deposits) on pelvic organs (43.91%),beaded or convoluted tubes (9.45%), hyperemic tubes (29.05%), caseous nodules in pelvis (29.72%), encysted ascites (14.18%), abdominal adhesions (32.43%), pelvic adhesions (42.56%), calcified and rigid tubes (6.08%). The new laparoscopic sigmoid colonic adhesive band was seen in 49 (33.10%) patients of FGTB., Conclusion: The new laparoscopic "Sharma's Sigmoid colonic adhesive band" appears to be an important finding in patients with FGTB., (Copyright © 2019 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Objectives: The objectives of this series are to evaluate the results of vaginal myomectomy and to assess the postoperative adhesion risk., Methods: It was a prospective observational study of fifty patients. All patients underwent a vaginal myomectomy, followed six months after laparoscopy to assess and treat postoperative adhesions., Results: Myomectomies were performed via an anterior, posterior and mixed colpotomy in 42 %, 54 % and 4 % of the cases, respectively. Laparoconversion was necessary in three cases (6 %). Laparoscopic evaluation was performed in 24 patients (48 %). adhesions were present in 14 cases (58.33 %); the adhesions did not affect the Fallopian tubes and ovaries., Conclusion: Vaginal myomectomy was feasible, not limited to single myomectomy this which is in agreement with previously published series. Post adhesion risk seems weaker and does not concern the appendices, but this requires to be confirmed., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)