Adhesions in patients with chronic pelvic pain: a role for adhesiolysis?
ABSTRACT To review the relation between adhesions and pelvic pain and the effectiveness of adhesiolysis in pain control.
Selective review of the literature.
Patients with pelvic pain and/or undergoing adhesiolysis for pain control.
Intraabdominal adhesions are accepted as etiologic factors for infertility and small bowel obstruction; however, the contribution of adhesions to pelvic pain is less clear. The most common laparoscopic findings in patients with and without pelvic pain were endometriosis and adhesions. Immunohistologic studies also have shown evidence of nerve fibers in adhesions that had been removed from patients with and without pelvic pain. Multiple adhesiolysis techniques have been employed, with outcome of surgical procedures ranging from no pain relief to pain relief in 90% of patients. However, randomized trials have shown that adhesiolysis is ineffective in improving the outcome of the treatment of pelvic pain, possibly because of adhesion reformation. Interestingly, adhesions are usually not described as an etiologic factor for pelvic pain in men; this might be related to a gender difference in pain perception or the possibility that adhesions per se do not cause pain.
The correlation between pelvic pain and adhesions is uncertain. Adhesiolysis has not been shown to be effective in achieving pain control in randomized clinical studies.
- SourceAvailable from: Ying C Cheong[Show abstract] [Hide abstract]
ABSTRACT: To explore recent developments in the techniques used for the prevention of adhesion formation after gynaecological surgery as well as the current evidence for existing agents and techniques. Recent developments are promising new biomaterials such as polyvinyl alcohol gel and hyaluronic acid cross-linked with various agents such as nanoparticles. Other substances that have recently received attention include novel anti-inflammatory agents, Oxiplex (FzioMed, Inc., San Luis Obispo, California, USA), sildenafil, statins and also, there has been some renewed interest in dextran. Furthermore, the combination of barrier and pharmacological agents has led to the introduction of interesting new hybrid systems. Finally, despite the development of many novel antiadhesion agents, good surgical technique remains the mainstay of adhesion prevention. There is preliminary evidence to support the use of hyaluronic acid, although the best preparation is yet to be determined. The use of icodextrin, Interceed (Ethicon Inc, Somerville, New Jersey, USA) and Oxiplex seem to be justified by the currently available data. The results of interesting new technologies such as the use of hybrid systems and new forms of biomaterials are awaited.Current Opinion in Obstetrics and Gynecology 08/2008; 20(4):345-52. DOI:10.1097/GCO.0b013e3283073a6c · 2.37 Impact Factor
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ABSTRACT: Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.Human Reproduction Update 03/2007; 13(4):379-94. DOI:10.1093/humupd/dml061 · 8.66 Impact Factor
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ABSTRACT: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin-filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 11(3):303-8. · 0.79 Impact Factor