The surgeon continued with lysis of adhesions
around the pelvis area.
Our minimally invasive gynecologic surgery (MIGS) team has utilized minilaparoscopy for diagnostic laparoscopy; lysis of adhesions
; treatment of stage I, II, and occasionally stage III endometriosis; ovarian cystectomy; ureterolysis; presacral neurectomy; and total laparoscopic hysterectomy--as has our guest author Steven McCarus, MD.
Here, we report a case of placenta accreta following hysteroscopic lysis of adhesions
caused by Asherman's syndrome and IVF treatment and review the literature on placenta accreta following hysteroscopic adhesiolysis.
Surgical management included an exploratory laparotomy with extensive lysis of adhesions
(LOA), repair of gastrocutaneous fistula, and end ileostomy with Hartmann's pouch.
Hysteroscopic lysis of adhesions
is the gold standard for treatment of intrauterine adhesions.
Raw surfaces from the lysis of adhesions
were profusely bleeding, pericardial cavity washed with warm saline and cell saver machine was on standby for use in case of uncontrolled bleeding.
For example, billing for both lysis of adhesions
and total abdominal hysterectomy in the same operation has long been denied, as preoperative and postoperative care typically are the same and the intraservice times are not appreciably different.
Prevention of adhesion reformation can be achieved by administering high-dose estrogen therapy postoperatively, by placement of a bladder catheter (size 8 pediatric with a 5 cc balloon) or intrauterine device (IUCD) into the uterine cavity immediately after lysis of adhesions
. The bladder catheter is removed from the uterus after 10 days and the IUCD is removed after three months (14).
Studies have recommended that if a conversion to an open lysis of adhesions
is necessary, it should be done sooner rather than later to reduce post-operative morbidity (3).
I usually reassure parents that the pain in a "lysis of adhesions
" is far less and far briefer than is the pain caused a child by an ordinary immunization.
He underwent exploratory laporatomy with resection of necrotic bowel and lysis of adhesions
. A central venous catheter was placed today, and post-insertion chest x-ray showed a pneumothorax.
Lysis of adhesions
, omental resection, and drainage of multiple loculations of infected fluid was performed.