Prevalence, patterns, and associated factors of intraperitoneal adhesions among women undergoing gynaecological laparoscopy at a private endoscopic centre in Southeastern Nigeria

Abstract

Background Intraperitoneal adhesions are a major cause of chronic pelvic pain, infertility, tubal ectopic pregnancy, intestinal obstruction and increased surgical time globally . Objective To determine the prevalence, pattern and factors associated with intraperitoneal adhesions among women undergoing laparoscopy in a private hospital in Southeastern Nigeria. Methods We conducted a retrospective analytical cross-sectional study involving women who underwent laparoscopy at a private endoscopic centre. Sociodemographic and clinical characteristics, indications, surgical history, indications for laparoscopy, and intraoperative findings were extracted from the medical records. Peritoneal adhesion index (PAI) scores were calculated for each patient; descriptive and bivariate analyses were conducted. Results A total of 384 women were included. The mean age was 34.89 ± 6.69 years, and the median parity was 0 (IQR: 0–1). Most of the women had endoscopy on account of infertility ( n = 307, 79.95%). The prevalence of intraperitoneal adhesions in the cohort was 49.22% (95% CI: 44.23% to 54.23%; n = 189/384), while the prevalence among women with previous surgery was 72.90% ( n = 78/107). Among women who had adhesions ( n = 189), the median PAI score was 6 (3–12) out of a total score of 30. The prevalence of adhesions was higher among women with primary infertility compared to women with secondary infertility ( p = 0.013). Previous abdominal surgery, type of surgery, and surgical indication were also significantly associated with adhesion formation ( p < 0.05). Conclusion Nearly half of the women undergoing laparoscopy had intraperitoneal adhesions. Targeted preventive strategies, including minimally invasive surgical approaches and improved reproductive health services, are essential to reduce adhesion-related morbidity. Factors predictive of intraperitoneal adhesions will assist with patient counselling, choice of therapy and optimal operative planning.