What You Need to Know About Removal of Pelvic Adhesions
Diagnosed with Pelvic Adhesions: What Does that Mean?
Pelvic adhesions are common in women who have extensive endometriosis that has been left untreated. Adhesions can 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 more common after open surgery, (meaning the surgeon used an 8-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 and post-surgery infection or bleeding can lead to adhesion formation due to increased inflammation during the healing process.
Pelvic adhesions can have an impact on a woman’s ability to conceive and carry a baby to term — particularly pelvic adhesions or scar tissue related to endometriosis.
This scar tissue can be completely asymptomatic in many cases. 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.
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Treatment for Pelvic Adhesions
If pelvic adhesions are causing bothersome symptoms, they should be treated with resection surgery, which removes the scar tissue. This is best performed as a minimally invasive procedure by laparoscopic specialists, who can ensure that additional adhesions do not form after the resection. The surgeons at The Center for Innovative GYN Care are fellowship-trained in minimally invasive laparoscopic surgery.
- 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 such as fibroids or adenomyosis 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.
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Understanding the Procedure & What to Ask Your Surgeon About Pelvic Adhesions
The surgeon’s skill level plays a role in the likelihood of adhesion formation after surgery. Gentle handling of the tissue, minimal blood loss and minimally invasive surgery decrease the risk of adhesions. Adhesion barriers are dissolvable materials that have been shown to decrease the risk. 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 finding relief. Many surgeons who perform laparoscopy do not have the advanced skills required to effectively and safely remove the pelvic adhesions. In the hands of a 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, which would continue to cause pain.
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, robotic methods continue to be used in GYN surgeries. This is because robotic procedures “enable” an OBGYN 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 incisions, one at the belly button and another at the bikini line. This minimally invasive procedure allows patients to have a better overall recovery. All procedures are performed in an outpatient setting so patients can return home the same day.
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GYN surgical specialists can often see women sooner than a standard OBGYN 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 they can have confidence from the very start. Our surgeons have performed over 25,000 GYN procedures and are constantly finding 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, MD and Reston, VA as well as in New York City and Montclair, NJ. Women looking for a GYN specialist for a laparoscopic hysterectomy, endometriosis excision or fibroid removal have traveled to CIGC from over 30 countries around the world.
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