Adhesions

[sotmac406]

I've had two previous laproscopic surgeries to remove patches of endometriosis and adhesions. Does having surgery increase my risk of adhesions developing? Or are they purely caused by the endometriosis?

[Mr Jonathan Broome]

Hello

Not an easy question to answer.

Endometriosis can certainly cause adhesions, sometimes the ovaries can stick to the pelvic side walls or the back of the uterus and in severe cases the bowel/rectum can become hitched up/stuck to the back of the cervix or womb.

Surgery to divide these adhesions causes raw edges (where adhesions are divided) that again can go on to cause further adhesions where these raw edges stick back together. Laparoscopic surgery is better than 'open' surgery at preventing adhesions and special fluids can be instilled into the pelvis at the end of an operation to try and reduce the risk of adhesion formation but in the end adhesion formation is a risk with any form of surgery.

Opinion is divided as to whether adhesions cause pain, provided all endometriosis is excised and there is no anatomical abnormality (fallopian tubes are free, ovaries mobile and ovulation unimpeded) then it's unlikely that post surgical adhesions are going to cause a problem.

Regards

[Mr Radwan Faraj]

Good question! Endometrisis will cause adhesions and any operation (not necessarily for endometriosis) will be followed by adhesions. You had 2 operations already for endometriosis, this ideally should be followed by medical treatment to reduce recurrence of endometiosis. This is like GnRh injections or even the Mirena coli.

Now , surgrical adhesions are unpreventable however the nature of surgery, the skills of the surgeon will help to reduce its development. I personally use certain material like Hyalobarrier gel to reduce risk of future adhesions. Please refer to my website www.faraj-gynaecology.co.uk and watch video clip on removing a cyst from the ovary and use of this gel

all the best

Mr R Faraj
www.faraj-gynaecology.co.uk