We analyzed the case histories and operation protocols of 2,465 female patients who had undergone pelviscopy for various reasons at the University Clinic of Obstetrics and Gynecology, Kiel, in the years 1978–1982. 1,743 patients (71%) had reported a previous appendectomy, of whom 965 had had no other intra-abdominal operation. 657 of the latter (68.1 %) presented adhesions; these were located in the right middle abdomen in 36.4% of the cases. In comparison to a collective of 308 patients without adhesions after appendectomy, the existence of chronic lower abdominal pain was independent of the presence of adhesions (30–31 % in both groups). In 55% of the patients with adhesions who were infertile after appendectomy, periovarian and peritubal adhesions were registered. In order to avoid unnecessary appendectomy or other laparotomies with later formation of adhesions, the use of laparoscopy is recommended in all questionable cases.
Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. A total of 63% of the patients had shoulder pain and 37.5% of the patients had sub-phrenic pain. 31.5% of the patients had a combination of both types of pain. Most of the sub-diaphragmatic pain was on the right side. In 93% of all patients the post-operative radiological investigation of the chest showed subphrenic gas. The remaining gas was aspirated and measured by infrared spectroscopy. All the remaining gas was carbon dioxide. The previously suggested absorption rates for carbon dioxide are probably too high. The transition of anaesthetic gas (e.g. N2O) through the peritoneum into the abdominal cavity as suggested by Hodgson, McClelland, and Newton was not detected in these measurements. The most likely cause of the post-laparoscopic pain syndrome is the effect of the volume of the remaining gas of the phrenic nerve.
By using a patient questionnaire, we checked the effects on sterilization of the unipolar high-frequency current method and the endocoagulation procedure in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) were hysterectomized; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy, primarily because of the recurrence of therapy-resistant menometrorrhagia. Of those women sterilized by the unipolar HF technique, 20 (7.8%) required 1–3 postoperative curettages, whereas only 8 patients (2.1%) of the endocoagulation group required such an operation. We found that 79 patients of the HF group (30.9%) exhibited menstrual disorders compared to only 45 women (11.7%) in the endocoagulation collective. By disregarding those patients who had taken the pill or used an IUD prior to sterilization, the corrected rates for occurrence of menstrual irregularities were 22.5% for the HF group and 5.9% for the endocoagulation group, respectively.
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