Pelvic adhesions (scar tissue) are usually caused by multiple pelvic/abdominal surgeries, infection, or endometriosis. Scar tissue can grow between two organs in the pelvic area making them stick together. These pelvic adhesions can occur around the bladder, bowel, ureter, uterus and ovaries. They are also more common after open surgery than laparoscopic surgery.

This scar tissue can be completely asymptomatic and not cause any problems. However, when it causes infertility, pain or gastrointestinal problems, such as bloating and constipation, surgical resection should be considered. Thorough resection of pelvic adhesions is essential in order to relieve pain and avoid new adhesions to form.

PM-PelvicAdhesions

 

Pelvic adhesions can involve different organs:

  • Bladder adhesions: these usually form after cesarean delivery. Multiple cesarean deliveries lead to dense adhesions between the bladder and the uterus. In order to avoid recurrent adhesions and pain, removal of the uterus through laparoscopic hysterectomy is recommended.
  • Bowel adhesions: these form after abdominal and pelvic surgeries like myomectomies, or after severe pelvic infection from a ruptured appendix or bowel injury. Careful dissection of the bowel with special scissors is required, and this should only be performed by an experienced surgeon.
  • Endometriosis adhesions: these can form as a result of extensive or longstanding endometriosis and can cause pain and infertility. These adhesions are usually very dense and involve important structures such as the rectum, large pelvic vessels, and ureters, they can be very difficult to resect. If the patient does not wish to preserve fertility, removal of the uterus with or without the ovaries should be considered.
  • Ureteral adhesions: these are adhesions around the tubes that connect the kidneys to the bladder. They are found in severe endometriosis. In rare cases, the extent of damage to the ureter from endometriosis requires ureteral reimplantation.

Resection of pelvic adhesions can be a very complicated procedure. In the hands of an unexperienced surgeon, it can result in injury to surrounding organs and a higher risk of conversion to open surgery. Laparoscopic resection of adhesions is the preferred method because it is safer and leads to less pain and faster recovery for the patient. Patients with severe endometriosis should seek care from a surgeon that is experienced in advanced laparoscopic procedures. Gentle handling of the tissue, minimal blood loss, and minimally invasive surgery decrease the risk of adhesion formation.

At CIGC, we perform minimally invasive resection of pelvic adhesions using the DualPortGYN technique. This approach uses only two 5 MM incisions and recovery time is 1 week. All procedures are performed in outpatient settings, and robotics are never used.

Read Dorran’s story, who was diagnosed with pelvic adhesions from endometriosis, after menopause.

BOOK A CONSULT

To schedule an appointment and get an evaluation with a CIGC specialist, call 888-SURGERY or contact us online. The DualPortGYN technique was developed by Dr. Paul MacKoul and Dr. Natalya Danilyants and has been successfully applied to thousands of GYN procedures.

The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Patients who reside outside the Washington DC area travel to CIGC for minimally invasive GYN surgery through our travel program.

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Endometriosis affects over 5 million women in the US alone, but it is still greatly misunderstood by patients and doctors. There is a need for better medical training in recognizing the symptoms and providing treatment that is thorough and efficient. Often is it up to the patient to be their own best advocate and keep looking for answers, and this can be a long and painful journey.

Addressing symptoms early is essential when it comes to this debilitating disease. Endometriosis has no cure, but it can be managed in order to achieve a better quality of life, and the ability to conceive. Take a look at these helpful facts to learn about the symptoms, and options for diagnosis and treatment.

ENDOMETRIOSIS SYMPTOMS

  • Endometriosis symptoms include pelvic pain, heavy bleeding, bloating and fatigue, difficulty urinating or having a bowel movement, and even difficulty getting pregnant or carrying a pregnancy to term.
  • Endometriosis pain can start as early as teen years (see Teen Health: What Severe Period Pain Could Really Mean) or as late as after menopause due to pelvic adhesions from endometriosis (see Dorran’s story).
  • There are various stages for endometriosis, from small deposits of endometriosis to the entire pelvis being stuck together. The stage though is not directly correlated with the pain. What is important is to diagnose and remove endometriosis, and then either treat with medical suppression, or try to become pregnant if the patient is looking to conceive.


GETTING DIAGNOSED

  • Symptoms are often dismissed as common or misdiagnosed by untrained professionals. It takes an average of 10 years for a woman to get diagnosed with endometriosis.
  • Endometriotic lesions are very small and they can’t be seen with imaging studies, such as ultrasound or CT scan. Exceptions to this are if endometriotic cysts are present in the ovaries.
  • A definitive diagnosis can only be made with diagnostic laparoscopy. This procedure allows for a small thin camera to be inserted into the abdomen, where the entire pelvis can be inspected and suspicious lesions can be resected for a diagnosis.


ENDOMETRIOSIS TREATMENT

  • There is no cure for endometriosis, but it can be managed medically, surgically, or with a combination of both.
  • Endometriosis excision preserves the uterus, tubes & ovaries for women who wish to maintain fertility, or who have milder disease. Complete removal of all instances of endometriosis is essential for long-term relief, and medical management can extend the length of pain control.
  • A minimally invasive hysterectomy with removal of both ovaries has been shown to alleviate many symptoms, particularly if the endometriosis is localized to the uterus. This is only effective if resection of endometriosis is performed simultaneously and all instances of endometriosis are removed.
  • Pelvic adhesions are common with endometriosis patients. If they are removed incorrectly, they can reform and create additional pain. Unless seen by a specialist first, it is very common for endometriosis patients to have increased pain from surgery performed incorrectly.

More on endometriosis treatment on InnovativeGYN.com

BOOK A CONSULT

At CIGC, minimally invasive endometriosis excision and laparoscopic hysterectomy is performed using the DualPortGYN technique, with two 5 MM incisions and 1 week recovery time. To schedule an appointment with an endometriosis specialist of CIGC Rupen Baxi MDNatalya Danilyants MD or Paul MacKoul MD, call 888-SURGERY or contact us online.

The Center for Innovative GYN Care has offices in Bethesda, MD, Annapolis, MD and Reston, VA. Out-of-town patients can travel to Washington DC for minimally invasive GYN surgery: discover the CIGC travel program.

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