Pelvic adhesions (scar tissue) are usually caused by multiple pelvic/abdominal surgeries, infection, or endometriosis. Scar tissue can grow between two organs in the pelvic area making them stick together. These pelvic adhesions can occur around the bladder, bowel, ureter, uterus and ovaries. They are also more common after open surgery than laparoscopic surgery.
This scar tissue can be completely asymptomatic and not cause any problems. However, when it causes infertility, pain or gastrointestinal problems, such as bloating and constipation, surgical resection should be considered. Thorough resection of pelvic adhesions is essential in order to relieve pain and avoid new adhesions to form.
Pelvic adhesions can involve different organs:
- Bladder adhesions: these usually form after cesarean delivery. Multiple cesarean deliveries lead to dense adhesions between the bladder and the uterus. In order to avoid recurrent adhesions and pain, removal of the uterus through laparoscopic hysterectomy is recommended.
- Bowel adhesions: these form after abdominal and pelvic surgeries like myomectomies, or after severe pelvic infection from a ruptured appendix or bowel injury. Careful dissection of the bowel with special scissors is required, and this should only be performed by an experienced surgeon.
- Endometriosis adhesions: these can form as a result of extensive or longstanding endometriosis and can cause pain and infertility. These adhesions are usually very dense and involve important structures such as the rectum, large pelvic vessels, and ureters, they can be very difficult to resect. If the patient does not wish to preserve fertility, removal of the uterus with or without the ovaries should be considered.
- Ureteral adhesions: these are adhesions around the tubes that connect the kidneys to the bladder. They are found in severe endometriosis. In rare cases, the extent of damage to the ureter from endometriosis requires ureteral reimplantation.
Resection of pelvic adhesions can be a very complicated procedure. In the hands of an unexperienced surgeon, it can result in injury to surrounding organs and a higher risk of conversion to open surgery. Laparoscopic resection of adhesions is the preferred method because it is safer and leads to less pain and faster recovery for the patient. Patients with severe endometriosis should seek care from a surgeon that is experienced in advanced laparoscopic procedures. Gentle handling of the tissue, minimal blood loss, and minimally invasive surgery decrease the risk of adhesion formation.
At CIGC, we perform minimally invasive resection of pelvic adhesions using the DualPortGYN technique. This approach uses only two 5 MM incisions and recovery time is 1 week. All procedures are performed in outpatient settings, and robotics are never used.
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To schedule an appointment and get an evaluation with a CIGC specialist, call 888-SURGERY or contact us online. The DualPortGYN technique was developed by Dr. Paul MacKoul and Dr. Natalya Danilyants and has been successfully applied to thousands of GYN procedures.
The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Patients who reside outside the Washington DC area travel to CIGC for minimally invasive GYN surgery through our travel program.
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