Pelvic adhesions refer to strong bands of tissue sticking organs together in an unnatural way. They are a common source of pain in many women.
There are four broad categories of adhesion formation:
- post-surgical: where there has been continued leakage of blood from the surgical margins
- residual pathology: where the excision of particular endometriosis has been incomplete, leaving tissue to continue to grow, bleed and eventually form further deep fibrous bands
- infective adhesions: where there has been a rupture of an organ (a burst appendix is a good example) or a transmitted infection (PID, chlamydia/gonorrhoea); treatment with appropriate antibiotics is the first line measure in dealing with any STD
- radiation adhesions: rare in general gynaecology, and seen in patients who may have undergone pelvic lymph node radiotherapy (eg cervical cancer); these patients generally remain under the care of an oncology team rather than a general gynaecologist.
Adhesion formation can be minimised with exemplary surgical technique.
Attention to detail and ensuring that there is the least blood loss will definitely minimise the risk of local adhesion formation. The use of a drain to catch any additional irrigation fluid or blood is also a well-proven technique to prevent adhesions.
In patients being treated for endometriosis, complete excision of all deposits/nodules of abnormal scar tissue is essential. When the ovaries are involved, using a ‘hitch’ (oophoropexy) to prevent direct tissue contact is another well-proven technique in advanced laparoscopy that will minimise painful ovarian adhesions reforming.
These techniques are hallmarks of surgery under the care of Dr Gordon and are routinely employed in any advanced laparoscopic procedure.