Gynecologic use of Sepraspray Adhesion Barrier for reduction of adhesion development after laparoscopic myomectomy: a pilot study.

OBJECTIVE: To assess the safety and efficacy of Sepraspray Adhesion Barrier (a modified hyaluronic acid and carboxymethylcellulose powder) after laparoscopic surgery, in view of both the high efficacy of Seprafilm Adhesion Barrier in reducing postoperative adhesions after open surgical procedures and the difficulty with laparoscopic delivery. DESIGN: Multicenter, randomized, reviewer-blinded trial. SETTING: Reproductive endocrinology and infertility clinics. PATIENT(S): Women undergoing laparoscopic myomectomy for indications including infertility. INTERVENTION(S): Randomization to treatment with (n = 21) or without (n = 20) Sepraspray Adhesion Barrier. MAIN OUTCOME MEASURE(S): Postoperative adhesions development was assessed at early second-look laparoscopy. Adhesions were scored using the modified American Fertility Society scoring system. RESULT(S): Surgical procedure duration length was 99 versus 102 minutes in the control versus Sepraspray Adhesion Barrier groups, respectively, with the median number of fibroids removed being two in each group and corresponding fibroid weights of 134 ± 103 versus 113 ± 161 g, respectively. Adhesions scores increased in both the control and Sepraspray Adhesion Barrier groups, with larger although nonstatistically significant increases noted in control subjects when evaluating for the anterior uterus, the posterior uterus, and the entire uterus. CONCLUSION(S): Laparoscopic application of Sepraspray Adhesion Barrier after myomectomy in this pilot study was associated with a trend toward a reduction in postoperative adhesion development, as well as an encouraging safety profile. Further evaluation is warranted. CLINICAL TRIAL NUMBER: Sepraspray Adhesion Barrier #NCT00624930.

Uterine cavity-myoma fistula after hysteroscopic myomectomy mimicking uterine perforation at hysterosalpingography: case report.

Fistula formation between the uterine cavity and the cavity of a subserosal myoma was diagnosed at laparoscopy/hysteroscopy in a 39-year-old woman with primary infertility. The patient had undergone 2 previous hysteroscopic resection procedures for removal of a submucosal myoma as part of infertility treatment. Hysterosalpingography demonstrated leakage of contrast medium from the uterine cavity, a characteristic feature of uterine perforation. At hysteroscopy/laparoscopy, a defect was observed in the posterior wall of the uterine cavity with connection to the cavity of a subserosal myoma without any tract to the peritoneal cavity. Laparoscopic myomectomy was performed to repair the uterine wall defect at the site of the fistula. Subsequently, the patient conceived after an office-based gonadotropin cycle therapy and is currently 20 weeks pregnant.

Embolization of a uterine arteriovenous malformation followed by a twin pregnancy.

BACKGROUND: Uterine arteriovenous malformation is a lesion that can cause recurrent pregnancy loss. Very few successful pregnancies have been reported after selective embolization of an arteriovenous malformation. CASE: A 42-year-old gravida 6 para 0 with a history of four first-trimester spontaneous abortions was found to have a uterine arteriovenous malformation by hysterosalpingogram, which was confirmed by magnetic resonance angiography. She underwent selective transcatheter embolization of the arteriovenous malformation. A twin gestation was later conceived via in vitro fertilization. The twins were delivered by cesarean at term. CONCLUSION: Uterine arteriovenous malformation can be successfully treated with selective embolization, with good obstetric outcome.