Adnexal adhesions: a prognostic staging and classification system based on a five-year survey of fertility surgery results at Chapel Hill, North Carolina.

From 1976 to 1980, the endocrinology and fertility service at the North Carolina Memorial Hospital, Chapel Hill, performed 108 lyses of adnexal adhesions, including those in 61 patients who also required salpingostomies. A follow-up of 6 months to 4 years in regard to pregnancy outcome was obtained in 90% of these patients. The extent of adnexal disease is described, and a simplified staging system is presented in this report. The stages are based on four independent observations: (1) extent of ovarian involvement in adhesive disease, (2) nature of the adhesions, (3) fimbrial patency, and (4) isthmic patency. Each of the adnexa was staged separately, and patients were classified according to the operation performed on the more favorable side. In an analysis of the results as defined by live births, with use of this system, a statistically significant (p = 0.01) gradient was demonstrated from minimal adhesions (46.7% births) to extensive adhesions (0 births). A similar strong gradient (p = 0.02) was demonstrated with salpingostomies, with a 30% birth rate with no adhesions ranging to 0% with extensive adhesions. This staging and classification system is particularly useful in offering realistic prognoses to patients who are contemplating adnexal operations.