Pelvic adhesions, sometimes referred to as “scar tissue”, are a common cause of both infertility and pelvic pain.
Pelvic adhesions can occur as a result of a variety of different conditions including endometriosis, pelvic infection, and previous abdominal or pelvic surgery. It is well known that pelvic adhesions develop over 90% of the time following major abdominal surgery. The most common types of surgery that predispose to the development of pelvic adhesions include the removal of uterine fibroids (myomectomy), treatment of endometriosis, removal of ovarian cysts, and the repair of obstructed fallopian tubes.
Many complications can occur as a result of pelvic adhesions. For example, it is thought that adhesions may be a significant factor in as much as 40% of cases of infertility. They are also thought to be responsible for up to 50% of cases of chronic pelvic pain. In addition, adhesions are typically responsible for 50-75% of cases of bowel obstruction. Although more recent data are lacking, the treatment of pelvic adhesions accounted for 3% of all surgical procedures performed in the United States in 1998, as well as 1% of all hospital admissions and 2% of all patients admitted for surgeries around that time.
How do pelvic adhesions occur?
Adhesions typically develop in response to injury, as part of the normal healing process. Immediately following injury, cells that cause healing (inflammatory cells) migrate to the site of the injury. Within seven days following injury, the scaffold for healing or adhesion formation has already developed. As a result, it appears that no new adhesions form more than seven days after an injury. Rather, the character of the adhesion changes, progressing from thin, filmy adhesions to more dense, vascular adhesions. The earlier in this process that adhesions can be removed, the less likely it is that they will recur and cause long-term problems.
Adhesion formation that occurs following surgery can be of two types; de novo adhesion formation or adhesion reformation. De novo adhesion formation means the formation of adhesions at a site that did not have any adhesions affecting it prior to surgery. This would include the formation of adhesions around the uterus following the removal of a fibroid tumor or the formation of adhesions around an ovary following removal of an ovarian cyst. Adhesion reformation refers to the recurrence of adhesions following a procedure designed to remove pre-existing pelvic adhesions. This difference is important, as the techniques described below may be very effective at preventing de novo adhesion formation, while they appear to be somewhat less effective at preventing adhesion reformation