leading to the conversion of fibrin from fibrinogen, thereby aiding clot formation. FLOSEAL was first used during laparoscopy for a diaphragmatic hernia repair and has since been used effectively in elective gyneco- logical procedures such as myomectomy, ovarian cystectomy [4], and treatment of endometriosis. It should not be considered as a first-line agent since the majority of hemorrhage can be controlled with meticulous surgical technique. However, if other laparoscopic surgical measures, including suturing, bipolar electrocautery, and the harmonic scalpel have failed, then it is an extremely useful sec- ondary adjunct. Conflict of interest The authors have no conflicts of interest to declare. References [1] Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequen- cy and maternal mortality. Obstet Gynecol 1987;69(3 Pt 1):333–7. [2] Shaw SW, Hsu JJ, Chueh HY, Han CM, Chen FC, Chang YL, et al. Management of pri- mary abdominal pregnancy: twelve years of experience in a medical centre. Acta Obstet Gynecol Scand 2007;86(9):1058–62. [3] Cristalli B, Guichaoua H, Heid M, Izard V, Levardon M. Abdominal ectopic pregnan- cy. Limits of laparoscopic treatment [In French]. J Gynecol Obstet Biol Reprod (Paris) 1992;21(7):751–3. [4] Ebert AD, Hollauer A, Fuhr N, Langolf O, Papadopoulos T. Laparoscopic ovarian cystectomy without bipolar coagulation or sutures using a gelatin–thrombin ma- trix sealant (FloSeal): first support of a promising technique. Arch Gynecol Obstet 2009;280(1):161–5. 0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2011.11.003 Effect of concomitant oophorectomy on the perioperative outcomes of laparoscopic hysterectomy☆ Keisha Jones, Oz Harmanli ⁎, Cara A. Robinson, Sertac Esin, Ayse Citil, Alexander Knee Department of Obstetrics and Gynecology, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA, USA article info Article history: Received 26 October 2011 Received in revised form 29 November 2011 Accepted 13 December 2011 Keywords: Laparoscopic hysterectomy Oophorectomy Perioperative complications Prophylactic oophorectomy ☆ Paper presented as an oral poster at the 37th Annual Scientific Meeting of the Society of Gynecologic Surgeons in San Antonio, Texas, USA, held April 11–13, 2011. ⁎ Corresponding author at: Urogynecology and Pelvic Surgery, Baystate Medical Center, Tufts University School of Medicine, 759 Chestnut Street, S1680, Springfield, MA 01199, USA. Tel.: +1 413 795 5608. E-mail address: oz.harmanli@bhs.org (O. Harmanli). The dilemma concerning elective oophorectomy continues to resurface as hysterectomy remains the most common major gyne- cologic surgery performed in the USA [1]. While the pendulum con- tinues to swing, there remains a paucity of information about the surgical outcomes of this practice. The objective of the present study was to assess whether concomitant adnexal removal at the time of laparoscopic hysterectomy has an impact on perioperative outcomes. This is an ancillary analysis from a database created at Baystate Medical Center, USA. The methods have been described previously [2]. This was a retrospective cohort, including all total and supra- cervical laparoscopic hysterectomies performed for benign conditions between November 1999 and August 2008. Patients with pelvic pain, endometriosis, pelvic mass, or endometrial hyperplasia were excluded. Patients were categorized based on the presence or absence of elective concomitant adnexal removal. After comparing baseline characteristics, comorbid conditions, and indications for surgery, perioperative outcomes were evaluat- ed including operating time, serious complications, and conversion to laparotomy. Of the 612 eligible cases, 249 (40.7%) included con- comitant oophorectomy. As expected, patients who underwent ad- nexal removal were slightly older (42±5 vs 47±7 years) and more likely to be postmenopausal. This difference did not seem to be clinically significant as a small difference in age would not likely translate into a clinical effect. The hysterectomy only group was more likely to have menorrhagia as the surgical indication and less likely to have pelvic organ prolapse. There were no significant differences in operating time ≥ 200 minutes, change in hemoglobin ≥ 2.5 g/dL, febrile morbidity, urinary tract injury, or serious complications. Conversion to laparotomy was significantly increased in women undergoing concomitant adnexal removal compared with hyster- ectomy only (11.1% vs 3.3%, Adjusted Relative Risk 3.34; 95% CI, 1.58–7.08; Table 1). The magnitude of these results varied by prior adnexal surgery in the patient and surgeons’ volume of work. Unadjusted estimates suggest that length of hospital stay greater than 24 hours was an increased risk for those with concom- itant adnexal removal (RR 1.60; 95% CI, 1.14–2.26; Table 1). Strati- fied estimates further indicate that, after adjusting, increased risk resides among patients whose surgery was performed by surgeons with a low volume of work. This study did not show an increased risk of complications when elective adnexal removal is performed with laparoscopic hysterectomy. Even after adjustment, there was an increased risk of conversion to laparotomy when hysterectomy was conducted with concomitant adnexal removal compared with hysterectomy alone. The present study provides clinicians with valuable information about the short-term effects of combining 84 BRIEF COMMUNICATIONS