|November 2003 · Vol. 15, No. 11
Techniques and tools to prevent pelvic adhesions
Microsurgical techniques, laparotomy versus laparoscopy, use of adjunctive therapy—our panelists relate their views on these issues and discuss which options they would choose in 4 different scenarios.
Alan DeCherney, MD, moderator, is professor, department of obstetrics and gynecology, and chief, division of reproductive endocrinology and infertility, David Geffen School of Medicine, University of California, Los Angeles.
William Hurd, MD,
is professor and chair, department of obstetrics and gynecology, Wright State University School of Medicine, Dayton, Ohio.
Kelly Pagidas, MD,
is reproductive endocrinologist and assistant professor of obstetrics and gynecology, Brown University, Providence, RI, and Tufts University, Boston, Mass.
Joseph S. Sanfilippo, MD, MBA,
is professor, department of obstetrics, gynecology, and reproductive sciences, University of Pittsburgh, and vice chairman of reproductive sciences, Magee-Womens
Hospital, Pittsburgh, Pa. He also serves on the OBG Management
Board of Editors.
Approximately 40% of people who undergo primary surgery develop adhesions and reformation occurs in 80% to 90% of cases.
Microsurgical techniques such as gentle handling of tissues, careful hemostasis, and avoidance of heat may help reduce the incidence.
Laparoscopy appears to be less likely to produce adhesions than laparotomy.
Ob/Gyns should be aware of the potential for adhesion-related bowel obstruction and take steps to prevent it.
Are adhesions a pathologic response to injury or a normal aspect of healing? Can they be avoided, or are preventive efforts part of the problem? How useful are the different barriers in gynecologic surgery? What is the ideal adjuvant?
OBG Management convened a panel of experts to explore these and other questions.