Adhesions are defined as an abnormal connection of tissue between two structures in the body. In the gynaecological case, we usually talk about adhesions between the bowel and pelvic organs or the bowel and abdominal wall. They are the result of a disruption in the smooth (peritoneal) lining of the abdominal cavity by;
- Infection eg pelvic Inflammatory disease
- Inflammation eg endometriosis
- Surgery eg appendicectomy
Open (abdominal) surgery is responsible for most pelvic adhesions by exposing tissue to the atmosphere during the initial operation and handling tissue and disrupting the normal structures. Laparoscopy has a much lower incidence of adhesion formation because tissues are not touched by our hands, the carbon dioxide used to inflate the abdomen is warmed and humidified and the magnified view used with the laparoscope allows us to be meticulous in stopping even the smallest amount of bleeding.
Adhesions may be present and cause no problems at all. Indeed it is known that adhesions responsible for symptoms are those that restrict or retard the normal function of the organs such as the bowel or ovaries. When this happens, they may cause;
- Restriction of normal function such as constipation
- Pain with intercourse
The best outcome is not to cause the adhesions in the first place (see above) but once present, they can be removed laparoscopically. Of course adhesions have a tendency to return because the act of removal often leaves a raw surface, some minor bleeding etc. We use a number of anti-adhesions agents to try and minimize this happening as well as employing the surgical principles described above.
They can also be quite hazardous. Apart from causing pain and other problems, removal of adhesions that stick the bowel to the abdominal wall or cover the ovaries, may put those organs at risk. A surgeon skilled in laparoscopic techniques and performing adhesiolysis in these locations commonly should be responsible for your surgery.