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Adhesions/Scarring (Pelvic)

Pelvic Adhesions and Scarring

Most women, especially if they are at least approaching middle age, have some degree of adhesions or scarring in their pelvis. These fibrous bands and membranes of tissue develop in response to physical stresses or disruption in the pelvis or to local inflammation. They are more likely to be significant if they result from pelvic injury or infection (including inflammation due to pelvic inflammatory disease), or from endometriosis (a condition in which the tissue that normally lines the uterus, the endometrium, begins appearing outside the uterus) or from previous abdominal or pelvic surgery (including Cesarean section).

The common condition of abnormal attachments between pelvic organs and structures can cause a range of symptoms. Virtua surgeons can resolve severe cases with surgery.

Adhesions and scarring can appear anywhere in the pelvis. Often these structures cause no symptoms or problems, but in many other women they indeed compromise well-being, health or function. When adhesions are a problem, they usually cause one or both of two primary symptoms:

  • pain. Unexplained pelvic pain is not uncommon in women. Patients often feel at a loss over its cause. This chronic discomfort, which can also wax and wane through the menstrual cycle, can significantly compromise a woman’s energy and lifestyle. Women who have had multiple pelvic surgeries are especially prone to the problem.
  • infertility. Adhesions and scarring can make it difficult for a woman to conceive. These structures and the physical stresses they create in the pelvis can become major anatomical factors in pregnancy, especially with regards the ability of the fallopian tube to capture an egg, transport the egg, permit fertilization and allow the egg to complete its transit into the uterus. Blocked Fallopian tubes are a common cause of infertility.
Why does the body form abdominal and pelvic adhesions? Formation of fibrous tissues is a  natural aftereffect of stress or trauma  to areas of connective tissue anywhere in the body. Some individuals scar more than others. Patients who have a natural proclivity to forming adhesions internally are more genetically likely to get them. The human body is thought to have evolved with this ability in the abdomen as a way to wall off inflammation. Before the age of surgery, for example, an individual with appendicitis might only have survived the condition if the body formed a fibrous seal-or thin scar-around the infection.

Examining Problem Tissue and Intervening

Scar tissue and adhesions are very difficult to detect with ultrasound, CT, MR imaging or any other diagnostic test, study or scan. The gynecologic specialist must usually visualize these tissues directly.

If necessary, the surgeon will usually examine the areas endoscopically. In the same laparoscopic procedure, the surgical team can cut and remove the problem tissue. Robotic surgery, used commonly at Virtua Our Lady of Lourdes, provides a superior method of locating and eliminating the adhesions and scar tissue. This approach permits the surgeon access to difficult-to-reach locations to a greater extent than even the most advanced forms of standard laparoscopy, and also affords excellent visualization.

Knowledgeable Resection

Adhesions from a previous infection or surgery generally tend to be more sheet-like, having a plastic-wrap type of consistency. Such tissue tends to be very amenable to laparoscopic surgical correction as long as the surgeon is careful to excise them at their attachments and remove the entire adhesion. Simply cutting these thing layers of tissue often results in the early reformation of the same adhesions. The key is to identify the base of the attachments and remove them completely at these connections to healthy tissue.

Patients tend to do very well after this type of minimally invasive surgery. The procedures often relieve pain or permit women to successfully achieve pregnancy, or both.

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