Classification of adnexal adhesions: a proposal and evaluation of its prognostic value.

A system of classification of adnexal disease is proposed. Hysterosalpingography is important to determine tubal patency (stage I) and to distinguish between the presence of rugae in early fillage of the ampullae (stage II) and their absence (stage III or IV). Diagnostic laparoscopy under general anesthesia with the double-puncture technique is recommended to inspect the ovaries thoroughly and to put adhesions on a stretch for evaluation of thin, avascular adhesions (A) and thick, vascularized adhesions (B). The extent of adnexal disease can be classified as stage I minimal if most or all of the ovarian surface is visible; stage II, over 50% of the ovary is visible; stage III, less than 50% of the ovary is visible; Stage IV, no ovarian surface is visible. Each adnexum should be described separately. The worst aspect of each adnexum should be described. The best adnexal classification should be used in describing the patient for purposes of comparing surgical treatments. Using this approach, the authors describe a gradient from stage I (best prognosis) to stage IV (poorest) in a personal series of 99 tuboplasties over a 10-year period.