Conditions

Adhesions in the pelvis are scar tissue that forms as a result of infection, inflammation or 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 the 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 two nights in hospital
• 7 to 10 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
• The use of a drain after surgery to remove gas, fluid and any blood
• Relocation of ovaries which reduces the risk of adhesions forming in the pelvis

Relocation of ovaries involves:

• Inserting a dissolving stitch into the ligament that joins the ovary to the uterus
• Attaching the stitch to a further 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 1-2 months later, the ovary returns to its normal position, but with a reduced risk of scar tissue forming