Adhesions and endometriosis: challenges in subfertility management : (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group).

There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.

Predicting formation of adhesions after gynaecological surgery: development of a risk score.

Purpose: Risk factors for post-surgical adhesions following gynaecological surgery have been identified, but their relative importance has not been precisely determined. No practical tool exists to help gynaecological surgeons evaluate the risk of adhesions in their patients. The purpose of the study was to develop an Adhesion Risk Score to provide a simple tool that will enable gynaecological surgeons to routinely quantify the risk of post-surgical adhesions in individual patients.

A European survey on awareness of post-surgical adhesions among gynaecological surgeons.

The present survey was conducted among gynaecological surgeons from several European countries to assess the actual knowledge and practice related to post-surgical adhesions and measures for reduction. From September 1, 2012 to February 6, 2013, gynaecological surgeons were invited to answer an 18-item online questionnaire accessible through the ESGE website. This questionnaire contained eight questions on care settings and surgical practice and ten questions on adhesion formation and adhesion reduction.

"Adhesions after abdominal, pelvic and intra-uterine surgery and their prevention".

We here present the full text of a patient leaflet we have designed, and routinely use, to provide preoperative education about adhesions to patients undergoing open or laparoscopic gynaecological surgery. The leaflet presents appropriate, patient-orientated information on the nature of adhesions, their causes and the health risks they may involve as well as on adhesiolysis and modern methods of adhesion prevention. As adhesion formation is not specific to gynaecological surgery, the leaflet can also be adapted for the purposes of general abdominal surgery.

Prevention of adhesions in gynaecological surgery: the 2012 European field guideline.

Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent.

Improved survival of patients with ovarian cancer in Northern Denmark, 1985-2004.

Objective: Ovarian cancer is a serious disease with a high mortality. Our aim was to examine changes in the survival of patients with ovarian cancer in Northern Denmark.

Study Design And Setting: Patients (no.

Laparoscopy for abdominal emergencies: evidence-based guidelines of the European Association for Endoscopic Surgery.

Background: Emergency laparoscopic exploration can be used to identify the causative pathology of acute abdominal pain. Laparoscopic surgery also allows treatment of many intraabdominal disorders. This report was prepared to describe the effectiveness of laparoscopic surgery compared to laparotomy or nonoperative treatment.

Clinical evaluation of a viscoelastic gel for reduction of adhesions following gynaecological surgery by laparoscopy in Europe.

Background: Commonly used adhesion prevention devices either cannot be applied or are difficult to use via laparoscopy. A viscoelastic gel was developed specifically for adhesion prophylaxis during minimally invasive surgery.

Methods: Randomized, third party-blinded, parallel-group design conducted at four centres.

Transvaginal hydrolaparoscopy: a new diagnostic tool in infertility investigation.

Background: To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo-ovarian structures in the management of patients with unexplained infertility.

Methods: A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy.

Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study.

Background: The objective of this study was to assess the safety and efficacy of a 0.5% ferric hyaluronate gel, in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy.

Methods: The study was a randomized (by computer-generated schedule), third party blinded, placebo-controlled, parallel-group design conducted at five centres in Europe.

Laparoscopic surgery in ectopic pregnancy.

Background: A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment versus conventional conservative abdominal surgery for tubal pregnancy.

Methods: Patients were stratified for age and risk determinants for ectopic pregnancy (EP). Forty-eight patients were treated by laparoscopy and 57 by laparotomy.

A cost-effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy.

We compared the cost-effectiveness of therapeutic laparoscopy and open laparotomy for treatment of laparoscopically diagnosed ectopic pregnancy. Clinical outcomes of ectopic pregnancy treatment were based on results of a randomised trial done between 1987 and 1989 at Sahlgrenska University Hospital (Göteborg, Sweden). We estimated costs for inpatient and follow-up care of ectopic pregnancy by the two methods.

Coecal volvulus following caesarean section.

A case of coecal volvulus following caesarean section is reported. The importance of knowing the possibility of intestinal obstruction during pregnancy and puerperium is underlined.

[Fertility after conservative surgical treatment of ectopic pregnancy, evaluated by a randomized trial].

In order to evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy, randomised trial of laparoscopy versus laparotomy was performed between May 1987 and June 1989. The study was conducted in a clinical university centre, Sahlgrens Hospital. A group a 105 patients with tubal pregnancy were stratified with regard to risk determinants and age randomized to laparoscopy or laparotomy.

Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial.

Objective: To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy.

Design: A randomized trial versus laparotomy was performed between May 1987 and June 1989.

Setting: The study was conducted in a clinical university center, the Sahlgrens Hospital.

Diagnosis and treatment of tubal pregnancy as related to risk determinants.

To evaluate whether identification of 'high risk' patients for ectopic pregnancy (EP) is beneficial for early recognition and treatment, 178 cases of tubal pregnancy were analysed. Patients with 'high risk' and 'low risk' for EP were compared for diagnostic procedures, clinical features and surgical management. The 'high risk' patients presented a shorter gestational length, lower blood loss volume, a smaller size of the tubal gestation, a lower rate of tubal rupture and underwent more conservative treatment.

Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy.

Objective: Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial.

Design: One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy.

Persistent trophoblast after conservative treatment of tubal pregnancy: prediction and detection.

The incidence of persistent trophoblast and risk of second surgical intervention after conservative treatment of tubal pregnancy are substantial. The preoperative and postoperative hCG patterns in patients with tubal pregnancy were studied to see whether this information could predict and detect persistent trophoblast at an early stage. Ninety-eight women with tubal pregnancy underwent conservative surgical treatment by laparoscopy or laparotomy.

Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy.

A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment with conventional conservative abdominal surgery for tubal pregnancy. Entry criteria were: size of the ectopic gestation less than 4 cm, hemodynamic stability, accessibility for laparoscopic treatment and a trained laparoscopist on duty. There was no difference between the groups regarding gestational duration, size and location of the ectopic gestation, or the mean preoperative hCG values.