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Michael East
M.B.B.S, FRANZCOG, FRCOG, MAOG

T +64 9 522 3797
F +64 9 520 9526

Level 2, Suite 3
Ascot Hospital
90 Greenlane Rd East
Remuera
Auckland 1051
New Zealand
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Adhesions

Adhesions in the pelvis are scar tissues that form mainly as a result of inflammation produced by either infection, endometriosis or trauma from past surgery.

Causes of adhesions include:

  • Following surgery (post operative adhesions)
  • Endometriosis (chronic inflammation)
  • Infection such as pelvic inflammatory disease

Adhesions often do not cause symptoms though pelvic pain is the most common symptom.

In order to diagnosis adhesions a history is taken to establish;

  • Pelvic pain
  • Symptoms of endometriosis (endometriosis may be found in association with adhesions)
  • Previous surgery

Treatment of Adhesions

A Laparoscopy may be indicated to diagnosis and divide adhesions.

Division of adhesions;

  • Laparoscopy (minimal access surgery) rather than a Laparotomy (larger abdominal incision) reduces the risk of further adhesions forming
  • Surgery takes 1-2 hours
  • Requires 1-2 nights in hospital
  • 10 to 14 days off work

To reduce adhesions forming after surgery we ensure the following;

  • Use of laparoscopic surgery (minimal access surgery) which is known to cause less scarring and adhesion formation
  • Good surgical technique to minimise bleeding
  • The use of antibiotics to reduce the risk of infection
  • Relocation of ovaries which reduces the risk of adhesions forming in the pelvis
  • Instillation of a special fluid (Adept) into the pelvic cavity to bathe the tissues while healing

Relocation of ovaries involves:

  • Inserting a dissolving stitch into the ovary and attaching that stitch to a ligament which lifts the ovaries away from the site of surgery
  • This reduces the risk of scarring between the ovaries and pelvic side wall
  • This is particularly useful in those women who have endometriosis excised from their pelvic side walls
  • When the stitch dissolves 10 days later, the ovary returns to its normal position, but with a reduced risk of scar tissue forming
  • Sometimes a brief second look surgery is needed to confirm that the ovary has released itself back to its normal position.