Safety and efficacy of postoperative continuous intra-peritoneal wash with lactated Ringer's for minimizing post-myomectomy pelvic adhesions: A pilot clinical trial

Abstract

Objectives To assess efficacy and safety of post-operative intra-peritoneal wash with lactated Ringer's for 48 h after myomectomy in reduction of adhesions compared to routine intra-operative irrigation. Study design A prospective, randomized trial that included 52 eligible participants who had undergone abdominal myomectomy. Participants were randomly allocated to a treatment group (n = 26) which was subjected to continuous peritoneal wash for 48 h via two intraperitoneal drains, and a control group (n = 26). The incidence of de novo adhesions and their severity and extent were scored at a second-look laparoscopy 8-10 weeks postoperatively. Adhesions were graded using the local adhesion barrier scoring system score. Adverse effects were also assessed and reported. Results There was no statistically significant difference in duration of hospital stay or in the incidence of adverse events. A significantly higher proportion of adhesion-free patients was found in the treatment group [11/23, 47.8%] compared to the control group [4/21, 19%] (P < 0.01). The mean number of pelvic sites covered by adhesions was significantly lower in the treatment group than in the control group (2.2 ± 0.3 versus 4.6 ± 0.8, P < 0.05). The total adhesion score was significantly lower in the treatment group than in the control group (2.1 ± 0.5 versus 4.8 ± 1.4, P < 0.05) and the adhesion score was significantly lower at most of the individual anatomical sites. Conclusions Application of postoperative intraperitoneal wash with lactated Ringer's solution for 48 h may have reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy.