Surgical Adhesions from Gynecologic Surgery

 

Da Vinci Robotic Surgery for Severe Abdominal Adhesion

Video taken from the channel: DR RK Mishra


 

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Video taken from the channel: The BMJ


 

Micro-presentation: Postoperative Adhesions in Gynecologic Surgery

Video taken from the channel: ASRM Webinars


 

Reducing the Risk of Adhesions in Complex Gynecology

Video taken from the channel: Ethicon


 

Contemporary Adhesion Prevention In Gynaecological Surgery

Video taken from the channel: BroadcastMed Network


 

Total Abdominal Hysterectomy | Atlas of Gynecologic Surgery

Video taken from the channel: Lippincott


 

Prevention of post operative adhesions in gynecologic surgery

Video taken from the channel: alaa mosbah


Infertility: Adhesions that form as a result of certain types of gynecologic surgery, especially tubal surgeries and surgeries to remove fibroids (myomectomies), are a common cause of infertility. Adhesions between the ovaries, fallopian tubes or pelvic walls can prevent an egg from the ovaries from getting into and through the fallopian tubes. Infertility: Adhesions that form as a result of certain types of gynecologic surgery, especially tubal surgeries and surgeries to remove fibroids (myomectomies), are a common cause of infertility. Adhesions between the ovaries, fallopian tubes or pelvic walls can prevent an egg from the ovaries from getting into and through the fallopian tubes.

Adhesions were not found to be significantly associated with the other laparoscopic gynecological surgery indications (Table 2). The most common laparoscopic gynecological surgery performed in our patients was diagnostic laparoscopy, laparoscopic ovarian cystectomy, laparoscopic adhesiolysis, and laparoscopic tubal ligation. Among open gynecologic procedures, ovarian surgery had the highest rate of readmissions directly related to adhesions (7.5/100 initial operations) (2).

In the Scottish experience, excepting laparoscopic sterilization procedures, open and laparoscopic gynecologic surgery was associated with comparable risk for adhesion-related hospital readmission (3). Adhesions form following gynecologic surgery regardless of whether surgery is performed via laparotomy or laparoscope. A laparoscopic surgical approach is preferable to an abdominal approach, and a vaginal or laparoscopic hysterectomy is preferable to an abdominal hysterectomy ( Adamson, 2011 ).

Postoperative adhesions in gynecologic surgery: a committee opinion Postoperative adhesions are a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Adherence to microsurgical principles and minimally invasive surgery may help to decrease postoperative adhesions. For example, after gynecologic surgery, adhesions account for 15–20% of infertility cases 10, 11. This vicious, and sometimes lethal, circle of consecutive operations adds an.

Although current evidence suggests that adhesion barriers placed at the time of laparoscopic gynecologic surgery reduce adhesion formation, clinical improvement has not been well reported. We hope this systematic review will stimulate critical evaluation of how surgical techniques, adhesiolysis, adhesion barriers, and multidisciplinary therapies impact subfertility, pain, and patients’. GYNECARE INTERCEED Adhesion Barrier is indicated as an adjuvant in open (laparotomy) gynecologic pelvic surgery for reducing the incidence of postoperative pelvic adhesions after meticulous hemostasis is achieved consistent with microsurgical principles. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery Fertil Steril 2008;90 (5 Suppl):S144-S149.

This statement from the practice committee of the American Society for Reproductive Medicine provides an update to what is known about pelvic adhesions and gynecologic surgery. It goes on to say that the use of some barriers, while effective in reducing postoperative adhesions.

List of related literature:

Childbirth via cesarean section or a previous gynecologic surgery may indicate the possibility of pelvic adhesions that may be encountered if the planned surgical procedure includes entering the peritoneal cavity.

“Berry & Kohn's Operating Room Technique E-Book” by Nancymarie Phillips
from Berry & Kohn’s Operating Room Technique E-Book
by Nancymarie Phillips
Elsevier Health Sciences, 2016

Some surgeons prefer to grasp each lateral side of the incision with towel clamps and elevate the entire incision away from underlying structures, such as the bowel and the uterus, when entering the peritoneum.

“Pfenninger and Fowler's Procedures for Primary Care E-Book: Expert Consult” by John L. Pfenninger, Grant C. Fowler
from Pfenninger and Fowler’s Procedures for Primary Care E-Book: Expert Consult
by John L. Pfenninger, Grant C. Fowler
Elsevier Health Sciences, 2010

Intraoperative Sigmoidoscopy in Gynecologic Surgery

“Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy” by Camran Nezhat, Farr Nezhat, Ceana Nezhat
from Nezhat’s Operative Gynecologic Laparoscopy and Hysteroscopy
by Camran Nezhat, Farr Nezhat, Ceana Nezhat
Cambridge University Press, 2008

Prophylactic ureteral catheterization in gynecologic surgery.

“Campbell-Walsh Urology: Expert Consult Premium Edition: Enhanced Online Features and Print, 4-Volume Set” by Alan J. Wein, Louis R. Kavoussi, Andrew C. Novick, Alan W. Partin, Craig A. Peters
from Campbell-Walsh Urology: Expert Consult Premium Edition: Enhanced Online Features and Print, 4-Volume Set
by Alan J. Wein, Louis R. Kavoussi, et. al.
Elsevier Saunders, 2011

Initially utilized in laparoscopic assisted vaginal hysterectomy, the laparoscope allowed the treatment of adnexal pathology or endometriosis and assistance in the release of the uterine structures and bladder flap from above, facilitating the vaginal approach in more complex cases.

“Hysterectomy: A Comprehensive Surgical Approach” by Ibrahim Alkatout, Liselotte Mettler
from Hysterectomy: A Comprehensive Surgical Approach
by Ibrahim Alkatout, Liselotte Mettler
Springer International Publishing, 2017

In patients with previous intra-abdominal surgery, this incision can allow the surgeon to perform lysis of adhesions before initiating the laparoscopic portion of the procedure.

“Complications of Urologic Surgery E-Book” by Samir S. Taneja
from Complications of Urologic Surgery E-Book
by Samir S. Taneja
Elsevier Health Sciences, 2009

Usually enough adhesions are formed to keep the vagina in place even after the sutures are removed.

“Current Therapy in Large Animal Theriogenology E-Book” by Robert S. Youngquist, Walter R. Threlfall
from Current Therapy in Large Animal Theriogenology E-Book
by Robert S. Youngquist, Walter R. Threlfall
Elsevier Health Sciences, 2006

We have had success using laparoscopic lysis of adhesions to create space and to aid in the placement of the catheter.

“Fundamentals of Pediatric Surgery” by Peter Mattei
from Fundamentals of Pediatric Surgery
by Peter Mattei
Springer New York, 2011

Preventing adhesions in gynecologic Surgery.

“The 5-minute Obstetrics and Gynecology Consult” by Paula J. Adams Hillard, Paula Adams Hillard
from The 5-minute Obstetrics and Gynecology Consult
by Paula J. Adams Hillard, Paula Adams Hillard
Lippincott Williams & Wilkins, 2008

Laparoscopic lysis of adhesions might be done for pain or to transform an abdominal hysterectomy into a vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy.

“Comprehensive Gynecology” by Gretchen M. Lentz, David M. Gershenson
from Comprehensive Gynecology
by Gretchen M. Lentz, David M. Gershenson
Elsevier Mosby, 2012

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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4 comments

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  • A close family member underwent a 12 hour surgery with ‘touch and go’ chance of survival. I remember when I was a child and had just received a vaccine; being older, I remember her rolling around the floor in absolute agony screaming. She had no chance of conceiving and then this…. go figure folks.

  • Me and My mom had our surgery together
    i had my surgery with my mom in the same operating table i did not have anasthesia because my brain did not develop. my mom was 26 and i was less than a day old. now my mom 33 and im 10

  • Omg…i just pass thru that 2 month ago due to ovarian cancer and still recovering sooooo painful i don’t want that someone go thru this never..God have mercy with me and still alive thanks Goodness 4 that Amen ��

  • Had this procedure done March 9 with the removal of a 20 lb ovarian tumor….they do literally take out your insides and place them on the table for inspection. I am lucky to be here.