What You Need To Know About Removal of Pelvic Adhesions

Pelvic Adhesions


Pelvic Adhesions

Pelvic adhesions are common in women who have endometriosis that is extensive, or left untreated. Adhesions also form after Cesarean sections or other types of open surgery, and can be the result of infections. Scar tissue can grow between two organs in the pelvic area and cause significant pelvic pain. Pelvic adhesions can occur around the bladder, bowel, ureter, uterus and ovaries.

Surgical procedures, such as myomectomy and endometriosis surgery, can also lead to adhesions. Adhesions are also more common after open surgery, (meaning the surgeon used an eight-inch incision to gain access to the pelvic cavity), than laparoscopic surgery. The risk of adhesions increases with the number of major abdominal and pelvic surgeries. Additionally, post-surgery infection or bleeding can lead to adhesion formation due to increased inflammation during the healing process.

This scar tissue can be completely asymptomatic and not cause any problems. However, when it causes infertility, pain or gastrointestinal problems, such as bloating and constipation, a woman might consider a procedure called resection of pelvic adhesions.

Pelvic adhesions can have an impact on a woman’s ability to conceive and carry a baby to term – particularly pelvic adhesions related to endometriosis.

Pelvic adhesions are treated if they are causing bothersome symptoms by resection surgery, which removes the scar tissue. This is best performed as a minimally invasive procedure by fellowship trained laparoscopic specialists, who can ensure that additional adhesions do not form after the resection.

  • Laparoscopic removal of scar tissue (lysis of adhesions) is most effective in patients with extensive adhesions and adhesions involving the bowel.
  • In cases of mild adhesions, cutting down of adhesions may not treat all of the pain; In these cases, other causes of pain need to be considered.
  • If scar tissue is caused by multiple cesarean deliveries, the removal of the uterus may be necessary to avoid adhesion reformation and repeat surgery.

Genetic factors make some patients more prone to form adhesions than others. Two patients may have the same surgery and complications, but one may form severe adhesions and the other no adhesions at all.

Diagnosed With Endometriosis, Pelvic Adhesions After Menopause


The surgeon’s skill level plays a role in adhesion formation. Gentle handling of the tissue, minimal blood loss, and minimally invasive surgery decrease the risk of adhesion formation. Adhesion barriers are dissolvable materials that have been shown to decrease the risk of adhesion formation. After a myomectomy the material is placed on the uterus to prevent the bowel from adhering to it.

Choosing a specialist to perform laparoscopic resection of pelvic adhesions is an important step in deciding to have surgery. Many surgeons who perform laparoscopy do not have the advanced skills required to effectively and safely take down the pelvic adhesions. In the hands of less experienced laparoscopic surgeon, resection of adhesions will result in higher risk of conversion to open surgery and injury to organs such as the bowel and bladder. It can also result in further adhesions forming after the procedure.

Although the American Medical Association and other leading medical societies have issued statements discouraging robotic GYN surgery techniques due to dramatically higher costs to patients without any medical advantages, robotics continue to be used in GYN surgeries. This is because robotic procedures “enable” an OB-GYN not well trained in laparoscopic GYN surgical techniques to complete a GYN surgery through a “minimally invasive” approach. This is why women need to ask if robotics will be used during a GYN surgery and to seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques.

Dr. Paul MacKoul and Dr. Natalya Danilyants developed DualPortGYN a minimally invasive technique used for minimally invasive resection of pelvic adhesions. At CIGC, this procedure uses only two 5MM incisions, one at the belly button, and another at the bikini line so patients have a better overall recovery and return home the same day. All procedures are performed in an outpatient setting, and robotics are never used.


GYN surgical specialists can often see women sooner because they are focused entirely on surgery. Each patient gets detailed, in depth attention from Dr. Natalya Danilyants and Dr. Paul J. MacKoul. This personalized care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul MD or Natalya Danilyants MD.

Offices are conveniently located throughout the Washington D.C. area in Rockville, Reston, and Annapolis, MD. Women looking for a GYN specialist for a laparoscopic hysterectomy, endometriosis excision or fibroid removal travel to CIGC from around the world.


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CIGC Travel Program

Even if you are not from the DC area, many patients travel to The Center for Innovative GYN Care for our groundbreaking procedures. We treat women from around the world who suffer from complex GYN conditions.

Learn more in our travel program.