Occasionally, adhesions can form without apparent reason. The tendency to form adhesions varies among patients, which is not surprising since people are different. Why some people form fewer adhesions than others with the same type of surgery is not known. Some adhesions cause pain, others do not. Some patients with extensive adhesions have no pain, whereas one small, well-placed adhesion can kink a loop of bowel and cause bowel obstruction.
When adhesions hurt, they hurt in the place they occur. Patients sometimes use terms such as "pulling" or "stretching" to describe adhesion pain. Adhesion pain would not be expected to vary with the menstrual cycle unless adhesions around an ovary get stretched by the slight growth of a cyst. Many patients with endometriosis have adhesions as well, and it is often not possible to determine whether their pain is due to adhesions or endometriosis.
After laparoscopic excision of endometriosis at St. Charles Medical Center, 2/3 of reoperated patients have the same or a reduced adhesion score. There is no evidence that dissection with scissors produces more adhesions than laser or electrocoagulation. In fact, a study comparing the tissue damage of laser and scissors concluded "The significant increase in tissue necrosis and the subsequent foreign body reaction that follows laser incision compared with microscissor incision lead us to conclude that sharp mechanical incision is the modality of choice."
If adhesions are present at the time of surgery, there is a good possibility they will reform in the exact location after their removal. Scar tissue develops more commonly when operating in and around the ovary and intestines. Significant adhesions rarely develop after operating strictly on the peritoneum of the pelvic floor.
INTERCEED, a cellulose fabric material, was thought to help prevent the formation of adhesions, but is no longer used in surgeries at St. Charles. This is because it has not actually been studied for use in endometriosis patients and 5 of 6 reoperated patients in whom INTERCEED was used had dense, vascular adhesions wherever it had been used. Also, an abstract presented at the 1991 American Fertility Society Annual Meeting showed that INTERCEED caused de novo adhesions in animals, even though no surgery was done.