Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial

Objective: To determine if 3 months of preoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids. Design: Prospective, randomized, clinical study. Setting: A tertiary care medical center. Patient(s): Women of reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal. Intervention(s): Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy for evaluating uterine adhesions after random allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery. Main Outcome Measure(s): Adhesion formation between treatment groups and by incision number and aggregate length. Result(s): Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo. For every additional centimeter of incision length, the total adhesion area over the uterine serosal surface increased by 0.55 cm². The number of myomas removed and the number of incisions were positively correlated with total adhesion area. Conclusion(s): Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions. Following the standards of good surgical technique, adhesions are minimized with fewer and smaller incisions.