Procedure Resection of Pelvic Adhesions

Overview and Types

Pelvic adhesions require advanced GYN surgical expertise. They are usually caused by multiple pelvic/abdominal surgeries, infection or endometriosis. The Center for Innovative GYN Care® surgical specialists use advanced minimally invasive GYN techniques for pelvic adhesion resection that provide great care & rapid recovery.

 

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Pelvic adhesions (scar tissue) are usually caused by multiple pelvic/abdominal surgeries, infection, or endometriosis. Scar tissue can be completely asymptomatic and not cause any problems. When scar tissue causes infertility, pain or gastrointestinal problems, such as bloating and constipation, surgical resection needs to be considered. It is important to understand, however, that each additional surgery can cause new adhesions to form.

LAPAROSCOPIC RESECTION OF PELVIC ADHESIONS.

Scar tissue can involve different organs and requires a certain degree of surgical skill to avoid complications. Laparoscopic resection of adhesions is the preferred method due to less pain, faster recovery, and less risk of new adhesions compared to open surgery. Many surgeons who perform laparoscopy do not have the skills required to effectively and safely take down the pelvic adhesions. In the hands of unexperienced 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.

BLADDER ADHESIONS

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These usually form after cesarean delivery. Multiple cesarean deliveries lead to dense adhesions between the bladder and the uterus. Patients who have had multiple cesarean deliveries should only have an experienced laparoscopic surgeon perform the operation to decrease the risk of bladder injury. To avoid recurrent adhesions and pain, removal of the uterus (hysterectomy) is recommended.

BOWEL ADHESIONS

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These form after abdominal and pelvic surgeries or severe pelvic infection. After myomectomy (removal of fibroids), the bowel can become adherent to the uterus and the abdominal wall. Prior pelvic infection from a ruptured appendix or bowel injury can also lead to severe bowel adhesions. Careful dissection of the bowel with special scissors is required to avoid injury. This procedure should only be performed by an experienced laparoscopic surgeon.

ENDOMETRIOSIS ADHESIONS

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These are the result of longstanding endometriosis and can cause pain and infertility. These adhesions can be very difficult to resect and should only be performed by an experienced laparoscopic surgeon. These adhesions are usually very dense and usually involve important structures such as the rectum, large pelvic vessels, and ureters. If the patient has completed childbearing, the removal of the uterus with or without the ovaries should be considered to effectively remove the adhesions and resolve pain. If childbearing is desired, careful dissection around the uterus, ovaries, and tubes is performed to avoid bleeding and injury.

URETERAL ADHESIONS

These are adhesions around the tubes that connect the kidneys to the bladder. These adhesions are usually found in severe endometriosis. Again, only an experienced surgeon should attempt to take down these adhesions to avoid injury to the ureter. In rare cases, the extent of damage to the ureter from endometriosis requires ureteral reimplantation (ureteroneocystostomy). In this procedure, the damaged segment of the ureter is removed and the healthy end is implanted directly into the bladder. Very few surgeons are able to perform this procedure laparoscopically, therefore patients with severe endometriosis should seek care from an experienced advanced laparoscopic surgeon.

Questions to Consider

Is Robotic Resection of Adhesions Safer Than Other Laparoscopic Methods?

Robotic resection of adhesions offers no benefit to the patient and is not the preferred method of operation. Robotic surgery requires a greater number and size of incisions without improvement in complications or outcome. Many gynecologic surgeons that use the robot have very little experience in resection of severe adhesions. This inexperience greatly increases the risk of bowel, bladder, and ureteral injury. Moreover, the inexperienced surgeon will not be able to repair the injury if one occurs.

The most dangerous potential complication is unrecognized or delayed bowel injury, which is discovered days after the surgery. This type of injury can result in severe infection and requires an open abdominal procedure to repair.

What Causes Adhesions and How Can Adhesions Be Prevented?

Formation of adhesions depends on multiple factors: surgical procedure, post-surgery infection or bleeding, genetic factors, use of adhesion barriers, and the surgeon’s skill level.

Surgical procedures such as myomectomy and endometriosis surgery can frequently lead to adhesions due to the extensive dissection sometimes required during these procedures. Open surgery generally causes more adhesions than laparoscopic surgery. The risk of adhesions increases with the number of major abdominal and pelvic surgeries.

Post Surgery infection or bleeding can lead to adhesion formation due to increased inflammation during the healing process.

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.

Adhesion barriers are dissolvable materials that have been shown to decrease the risk of adhesion formation. After a myomectomy, for example, the material is placed on the uterus to prevent the bowel from adhering to the uterus.

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.

Our Advantage

WHY CIGC® FOR MY RESECTION OF PELVIC ADHESIONS?

Because pelvic adhesions can be tricky to treat – there is always the chance that surgery can exacerbate the problem or cause new adhesions to form – it is important to leave your treatment in the hands of an experienced GYN specialist.

Why CIGC?

The surgeons at CIGC have a niche focus: minimally invasive techniques for GYN surgery that facilitate optimal care and rapid recovery. Gynecological surgery is the only medicine we practice; meanwhile, it is only a secondary component of what your OB/GYN practices. All of our surgeons have undergone extensive training to become board-certified and fellowship-trained in Minimally Invasive Technology or Gynecological Oncology.

We use minimally invasive laparoscopic surgery for resection of pelvic adhesions. Laparoscopy is the preferred method due to less pain, faster recovery, and the lowest risk of new adhesions. We have performed thousands of these procedures and are extremely experienced.

At CIGC, our specialists have made a commitment to surgery. We perform a high volume of cases, see a wide range of case types, and undergo comprehensive training sessions. Being in the care of a surgeon who is inexperienced in laparoscopy when being treated for pelvic adhesions could leave you with even more scar tissue and pain.

As a patient, it is your decision where to get treated. As experts in the field, we help patients find peace of mind in the form of nuanced expertise and years of experience. If you want to know more about the practices and techniques we employ to treat your pelvic adhesions, don’t hesitate to give us a call at (888) 787-4379.

We have offices in Rockville and Annapolis, Maryland, as well as in Reston, Virginia for your convenience.