Adhesion prevention

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Adhesions are bands of scar-like, fibrous tissue that can form when there is any kind of tissue injury. According to Van Den Beukel et al. (2017), adhesions can cause pelvic pain. They also reports that “reformation of adhesions has been linked to relapse of pain after adhesiolysis” (Van Den Beukal et al., 2017). Hermann and Wilde (2016) note that adhesion formation is “highly prevalent in patients with a history of operations or inflammatory peritoneal processes”. (Endometriosis is an inflammatory disorder.) Careful technique at surgery can help minimize postoperative adhesions.

(More about adhesions can be found at: Adhesions)

Adhesion prevention 

  • Koninckx, P. R., Gomel, V., Ussia, A., & Adamyan, L. (2016). Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertility and sterility106(5), 998-1010. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/27523299

“Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% N2O to the CO2 pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.”

References

Herrmann, A., & De Wilde, R. L. (2016). Adhesions are the major cause of complications in operative gynecology. Best Practice & Research Clinical Obstetrics & Gynaecology35, 71-83. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1521693415001935

Van Den Beukel, B. A., de Ree, R., van Leuven, S., Bakkum, E. A., Strik, C., van Goor, H., & ten Broek, R. P. (2017). Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Human Reproduction Update23(3), 276-288. Retrieved from https://academic.oup.com/humupd/article/23/3/276/3058801