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Hysterectomy: pelvic adhesions HYSTERECTOMY: PELVIC ADHESIONS
Infections and surgical procedures are common causes of adhesions, which are filmy or thick strands of scar tissue that bind organs together. Adhesions can develop between the uterus, ovaries, bowel, bladder and rectum because of their proximity in the abdomen. Pain can occur any time that adhesions are stretched, for example during movement, a pelvic examination, sexual intercourse, passing urine or a bowel motion. If adhesions are constricting the ovary, pain may occur only, or mainly, during ovulation; if constricting the bladder, the pain may be intense when the bladder is full, easing as the bladder empties. Adhesions can also result in infertility by constricting the Fallopian tubes, covering or displacing the ovaries, or impeding the movement of sperm and egg or interfering with the growth of embryos. Ironically, while hysterectomy is sometimes successful in overcoming pain caused by adhesions, hysterectomy itself may be responsible for severe adhesions that result in long-term pain and intestinal obstruction.
The diagnosis of pelvic adhesions in a woman relies mainly on her history of infections or surgery and the nature of her pain. The diagnosis is usually confirmed by laparoscope although ultrasound can be useful in revealing adhesions surrounding the ovaries or bowel. If laparoscopy is performed in the presence of extensive adhesions it can result in puncture of the bowel, so great care must be taken with this technique and alternative methods (such as a mini-laparotomy) may have to be considered. (A mini-laparotomy entails a small incision through the abdominal wall to allow inspection of the internal organs. It is like a mini-Caesarean section.)
It is possible to remove adhesions without going to the lengths of hysterectomy in most women, and one of the most useful techniques is laparoscopic surgery. The laparoscope or viewing tube (for inspecting the internal organs) is used in conjunction with fine forceps which can hold the adhesions steady or break them with a blunt action, scissors to cut the adhesions, lasers to vaporise them, or high frequency electrical currents that produce heat and destroy them. In order to minimise adhesion formation, it is important that your surgeon is gentle and careful in his or her handling of the tissues, that techniques are used to prevent bleeding, and that solutions or
special membranes to reduce adhesion formation and other complications are used in the abdomen.
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