Pelvic adhesions (scar tissue) commonly result from surgery for fibroids, endometriosis, and ovarian cysts. In the patient trying to attain pregnancy, these adhesions may be a significant problem in achieving that goal. Over the past 25 to 30 years, innumerable products have been used in an attempt to minimize or prevent adhesions following these surgeries. These have included mysterious combinations of liquids, drugs, antibiotics, and antiinflammatories, "barriers" placed in between pelvic structures, and thick liquids. Some of these barriers are absorbable, others not. With few exceptions, none have been very successful in preventing postoperative adhesions. Two factors are generally accepted as important to the development of adhesions following pelvic surgery. The first (and most important) is good surgical technique. Utilization of standard microsurgical techniqes is the single factor that is most influencial in minimizing postoperative adhesions. Regardless of any other factors, poor technique (excessive tissue destruction) produces the worst outcome. Although postoperative adhesions commonly occur following any gynecologic surgery, good microsurgical techniques help minimize this problem (as much as is humanly possible).
Secondly, the route used to accomplish surgery is thought to be important. It is generally accepted that procedures performed by laparoscopic techniques result in fewer postoperative adhesions than the same procedures performed at laparotomy. Unfortunately this belief has not yet been clinically proven. Clinical research has, however, shown a greater chance of denovo adhesion formation after laparotomy. Denovo adhesions occur at sites where no surgical procedure was performed or no adhesions were present before the surgery was performed. Again, these adhesions are less likely to occur following laparoscopic procedures.
Several new adhesion-prevention products are currently in clinical trials undertaken to evaluate their effectiveness in minimizing postoperative adhesions. These products are being evaluated for their ability to limit postoperative adhesions following laparoscopic surgery for endometriosis, myoma (fibroids), adhesions, endometriosis and benign ovarian masses. You may contact the offices of any of the following WSG physicians for information concerning these studies. You must be able to travel to that physician's office for consultation and undergo the surgical procedure in the hospital where that physican practices.
Contact Dr. Johns' Clinical Research Coordinator (Vicki) at: gen@womenssurgerygroup.com
Please include as much clinical information about yourself and your condition as possible.
Alan Johns, M.D.