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

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. (C) 2014 Elsevier Ireland Ltd. All rights reserved.