Skip to main content
SpringerLink
Log in

Adhesions: Effects on Fertility and Prevention

  • Chapter
Reproductive Surgery in Assisted Conception

Abstract

Adhesions connect two or more points of organs or tissues that are normally separate and can be considered as the most common complication of abdominal and pelvic surgery. They have the potential to cause serious adverse effects such as small bowel obstruction, secondary infertility and can lead to increasingly complicated high risk operative procedures. Studies have illustrated the high burden placed on healthcare resources, with around a third of patients being readmitted for a related cause over 10 years, and upwards of an annual $2 billion inpatient expenditure on related disease in the US.

Adhesions form after damage to peritoneum when a fibrin clot, produced as part of the healing process persists instead of being fully reabsorbed. Any intraperitoneal organ may become involved in adhesions, with abdominal adhesions important in relation to fertility surgery due to potential operative complications, and pelvic adhesions potentially interfering with the processes leading to fertilization and implantation. A number of scoring systems have been developed to aid comparability and prognosis, such as the American Fertility Society adhesion score.

Adhesiolysis has been demonstrated to be effective in improving fertility but its benefit is limited due to high rates of reformation of divided adhesions and formation of de-novo adhesions. Prevention of adhesions would be the best solution and there is evidence from meta-analysis that some types of barrier agents reduce adhesion formation, but no evidence that they are cost-effective or have any effect on live birth rate, pelvic pain or quality of life. Clinicians are advised to be aware and to inform patients of the frequency and spectrum of complications that can result from adhesions resulting from surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007;9 Suppl 2:25–34.

    Article  PubMed  Google Scholar 

  2. Lower AM, Hawthorn RJS, Clark D, Boyd JH, Finlayson AR, Knight AD, et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24,046 patients. Hum Reprod. 2004;19(8):1877–85.

    Article  CAS  PubMed  Google Scholar 

  3. Howard FM, El-Minawi AM, Sanchez RA. Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol. 2000;96(6):934–9.

    Article  CAS  PubMed  Google Scholar 

  4. Hammoud A, Gago LA, Diamond MP. Adhesions in patients with chronic pelvic pain: a role for adhesiolysis? Fertil Steril. 2004;82(6):1483–91.

    Article  PubMed  Google Scholar 

  5. Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005;7(6):551–8.

    Article  CAS  PubMed  Google Scholar 

  6. Menzies D, Ellis H. Intestinal obstruction from adhesions–how big is the problem? Ann R Coll Surg Engl. 1990;72(1):60–3.

    PubMed Central  CAS  PubMed  Google Scholar 

  7. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg. 2001;18(4):260–73.

    Article  CAS  PubMed  Google Scholar 

  8. Metwally M, Watson A, Lilford R, Vandekerckhove P. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2008;(2):CD001298.

    Google Scholar 

  9. Ahmad G, Duffy JMN, Farquhar C, Vail A, Vandekerckhove P, Watson A, et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane database Syst. Rev. 2008;(2):CD000475.

    Google Scholar 

  10. Hershlag A, Diamond MP, DeCherney AH. Adhesiolysis. Clin Obstet Gynecol. 1991;34(2):395–402.

    Article  CAS  PubMed  Google Scholar 

  11. Stanciu D, Menzies D. The magnitude of adhesion-related problems. Colorectal Dis. 2007;9 Suppl 2:35–8.

    Article  PubMed  Google Scholar 

  12. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–80.

    Article  CAS  PubMed  Google Scholar 

  13. Wilson MS, Menzies D, Knight AD, Crowe AM. Demonstrating the clinical and cost effectiveness of adhesion reduction strategies. Colorectal Dis. 2002;4(5):355–60.

    Article  PubMed  Google Scholar 

  14. Wilson MS. Practicalities and costs of adhesions. Colorectal Dis. 2007;9 Suppl 2:60–5.

    Article  PubMed  Google Scholar 

  15. Sikirica V, Bapat B, Candrilli SD, Davis KL, Wilson M, Johns A. The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg. 2011;11:13.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Imudia AN, Kumar S, Saed GM, Diamond MP. Pathogenesis of Intra-abdominal and pelvic adhesion development. Semin Reprod Med. 2008;26(4):289–97.

    Article  CAS  PubMed  Google Scholar 

  17. Saed GM, Diamond MP. Modulation of the expression of tissue plasminogen activator and its inhibitor by hypoxia in human peritoneal and adhesion fibroblasts. Fertil Steril. 2003;79(1):164–8.

    Article  PubMed  Google Scholar 

  18. Ivarsson ML, Holmdahl L, Falk P, Mölne J, Risberg B. Characterization and fibrinolytic properties of mesothelial cells isolated from peritoneal lavage. Scand J Clin Lab Invest. 1998;58(3):195–203.

    Article  CAS  PubMed  Google Scholar 

  19. Diamond MP, El-Hammady E, Wang R, Saed G. Regulation of matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1 by dichloroacetic acid in human fibroblasts from normal peritoneum and adhesions. Fertil Steril. 2004;81(1):185–90.

    Article  CAS  PubMed  Google Scholar 

  20. Saba AA, Godziachvili V, Mavani AK, Silva YJ. Serum levels of interleukin 1 and tumor necrosis factor alpha correlate with peritoneal adhesion grades in humans after major abdominal surgery. Am Surg. 1998;64(8):734–6; discussion 737.

    CAS  PubMed  Google Scholar 

  21. Chegini N, Rong H, Bennett B, Stone IK. Peritoneal fluid cytokine and eicosanoid levels and their relation to the incidence of peritoneal adhesion. J Soc Gynecol Investig. 1999;6(3):153–7.

    Article  CAS  PubMed  Google Scholar 

  22. Buyalos RP, Funari VA, Azziz R, Watson JM, Martinez-Maza O. Elevated interleukin-6 levels in peritoneal fluid of patients with pelvic pathology. Fertil Steril. 1992;58(2):302–6.

    CAS  PubMed  Google Scholar 

  23. Rout UK, Saed GM, Diamond MP. Transforming growth factor-beta1 modulates expression of adhesion and cytoskeletal proteins in human peritoneal fibroblasts. Fertil Steril. 2002;78(1):154–61.

    Article  PubMed  Google Scholar 

  24. Roberts AB. Transforming growth factor-beta: activity and efficacy in animal models of wound healing. Wound Repair Regen. 1995;3(4):408–18.

    Article  CAS  PubMed  Google Scholar 

  25. Chegini N. The role of growth factors in peritoneal healing: transforming growth factor beta (TGF-beta). Eur J Surg Suppl. 1997;577:17–23.

    PubMed  Google Scholar 

  26. Diamond MP, El-Hammady E, Munkarah A, Bieber EJ, Saed G. Modulation of the expression of vascular endothelial growth factor in human fibroblasts. Fertil Steril. 2005;83(2):405–9.

    Article  CAS  PubMed  Google Scholar 

  27. Jones PA, Werb Z. Degradation of connective tissue matrices by macrophages. II. Influence of matrix composition on proteolysis of glycoproteins, elastin, and collagen by macrophages in culture. J Exp Med. 1980;152(6):1527–36.

    Article  CAS  PubMed  Google Scholar 

  28. Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Gynecol. 2007;14(1):15–22.

    Article  PubMed  Google Scholar 

  29. Juntunen K, Mäkäräinen L, Kirkinen P. Outcome after a high number (4–10) of repeated caesarean sections. BJOG. 2004;111(6):561–3.

    Article  PubMed  Google Scholar 

  30. Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci. 2011;18(12):1166–85.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Broekhuizen FF, Haning RV, Shapiro SS. Laparoscopic findings in twenty-five failures of artificial insemination. Fertil Steril. 1980;34(4):351–5.

    CAS  PubMed  Google Scholar 

  32. Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc. 1997;4(3):353–6.

    Article  CAS  PubMed  Google Scholar 

  33. Levrant S, Bieber E, Barnes R. Risk of anterior abdominal wall adhesions increases with number and type of previous laparotomy. J Am Assoc Gynecol Laparosc. 1994;1(4, Part 2):S19.

    Article  PubMed  Google Scholar 

  34. Brill AI, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol. 1995;85(2):269–72.

    Article  CAS  PubMed  Google Scholar 

  35. Darougar S, Forsey T, Wood JJ, Bolton JP, Allan A. Chlamydia and the Curtis-Fitz-Hugh syndrome. Br J Vener Dis. 1981;57(6):391–4.

    PubMed Central  CAS  PubMed  Google Scholar 

  36. Levinson CJ, Swolin K. Postoperative adhesions: etiology, prevention, and therapy. Clin Obstet Gynecol. 1980;23(4):1213–20.

    Article  CAS  PubMed  Google Scholar 

  37. Portuondo JA, Melchor JC, Neyro JL, Alegre A. Periovarian adhesions following ovarian wedge resection or laparoscopic biopsy. Endoscopy. 1984;16(4):143–5.

    Article  CAS  PubMed  Google Scholar 

  38. Sotrel G. Is surgical repair of the fallopian tubes ever appropriate? Reviews in Obstetrics & Gynecology. 2009;2(3):176–85.

    Google Scholar 

  39. Hulka JF. Adnexal adhesions: a prognostic staging and classification system based on a five-year survey of fertility surgery results at Chapel Hill. N C Am J Obstet Gynecol. 1982;144(2):141–8.

    CAS  Google Scholar 

  40. Wu CH, Gocial B. A pelvic scoring system for infertility surgery. Int J Fertil. 1988;33(5):341–6.

    CAS  PubMed  Google Scholar 

  41. Wu CH, Minassian SS. Assessment of infertility surgery by a pelvic scoring system. Int J Fertil. 1989;34(1):56–61.

    CAS  PubMed  Google Scholar 

  42. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49(6):944–55.

    Google Scholar 

  43. Johns DB, Keyport GM, Hoehler F, DiZerega GS. Reduction of postsurgical adhesions with Intergel adhesion prevention solution: a multicenter study of safety and efficacy after conservative gynecologic surgery. Fertil Steril. 2001;76(3):595–604.

    Article  CAS  PubMed  Google Scholar 

  44. Fossum GT, Silverberg KM, Miller CE, Diamond MP, Holmdahl L. Gynecologic use of Sepraspray Adhesion Barrier for reduction of adhesion development after laparoscopic myomectomy: a pilot study. Fertil Steril. 2011;96(2):487–91.

    Article  PubMed  Google Scholar 

  45. Nagata Y, Honjou K, Shindou M, Kawarabayashi T, Shirakawa K. The effects of periovarian adhesions of the results of IVF-ET Treatment. J Fertil Implant (Tokyo). 1997;14:54–7.

    Google Scholar 

  46. Improvement of interobserver reproducibility of adhesion scoring systems. Adhesion Scoring Group. Fertil Steril. 1994;62(5):984–8.

    Google Scholar 

  47. Stovall TG, Elder RF, Ling FW. Predictors of pelvic adhesions. J Reprod Med. 1989;34(5):345–8.

    CAS  PubMed  Google Scholar 

  48. Mahadevan MM, Wiseman D, Leader A, Taylor PJ. The effects of ovarian adhesive disease upon follicular development in cycles of controlled stimulation for in vitro fertilization. Fertil Steril. 1985;44(4):489–92.

    CAS  PubMed  Google Scholar 

  49. Molloy D, Martin M, Speirs A, Lopata A, Clarke G, McBain J, et al. Performance of patients with a “frozen pelvis” in an in vitro fertilization program. Fertil Steril. 1987;47(3):450–5.

    CAS  PubMed  Google Scholar 

  50. Bowman MC, Cooke ID, Lenton EA. Investigation of impaired ovarian function as a contributing factor to infertility in women with pelvic adhesions. Hum Reprod. 1993;8(10):1654–6.

    CAS  PubMed  Google Scholar 

  51. Diamond MP, Pellicer A, Boyers SP, DeCherney AH. The effect of periovarian adhesions on follicular development in patients undergoing ovarian stimulation for in vitro fertilization-embryo transfer. Fertil Steril. 1988;49(1):100–3.

    CAS  PubMed  Google Scholar 

  52. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093–9.

    CAS  PubMed  Google Scholar 

  53. Karasick S, Goldfarb AF. Peritubal adhesions in infertile women: diagnosis with hysterosalpingography. AJR Am J Roentgenol. 1989;152(4):777–9.

    Article  CAS  PubMed  Google Scholar 

  54. Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg H-R, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010;107(44):769–75.

    PubMed Central  PubMed  Google Scholar 

  55. Guerriero S, Ajossa S, Lai MP, Mais V, Paoletti AM, Melis GB. Transvaginal ultrasonography in the diagnosis of pelvic adhesions. Hum Reprod. 1997;12(12):2649–53.

    Article  CAS  PubMed  Google Scholar 

  56. Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64(3):486–91.

    CAS  PubMed  Google Scholar 

  57. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  58. Tulandi T, Collins JA, Burrows E, Jarrell JF, McInnes RA, Wrixon W, et al. Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions. Am J Obstet Gynecol. 1990;162(2):354–7.

    Article  CAS  PubMed  Google Scholar 

  59. Gomel V. Salpingo-ovariolysis by laparoscopy in infertility. Fertil Steril. 1983;40(5):607–11.

    CAS  PubMed  Google Scholar 

  60. Semm K. Change in the classic gynecologic surgery: review of 3,300 pelviscopies in 1971–1976. Int J Fertil. 1979;24(1):13–20.

    CAS  PubMed  Google Scholar 

  61. Vrijland WW, Jeekel J, van Geldorp HJ, Swank DJ, Bonjer HJ. Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc. 2003;17(7):1017–22.

    Article  CAS  PubMed  Google Scholar 

  62. Chapron C, Pierre F, Harchaoui Y, Lacroix S, Béguin S, Querleu D, et al. Gastrointestinal injuries during gynaecological laparoscopy. Hum Reprod. 1999;14(2):333–7.

    Article  CAS  PubMed  Google Scholar 

  63. Diamond MP, Daniell JF, Feste J, Surrey MW, McLaughlin DS, Friedman S, et al. Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery. Fertil Steril. 1987;47(5):864–6.

    CAS  PubMed  Google Scholar 

  64. Trew G, Pistofidis G, Pados G, Lower A, Mettler L, Wallwiener D, et al. Gynaecological endoscopic evaluation of 4 % icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod. 2011;26(8):2015–27.

    Article  CAS  PubMed  Google Scholar 

  65. Ten Broek RPG, Kok-Krant N, Bakkum EA, Bleichrodt RP, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Hum Reprod Update. 2013;19(1):12–25.

    Article  PubMed  Google Scholar 

  66. Gürgan T, Kişnişçi H, Yarali H, Develioğlu O, Zeyneloğlu H, Aksu T. Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease. Fertil Steril. 1991;56(6):1176–8.

    PubMed  Google Scholar 

  67. Alborzi S, Motazedian S, Parsanezhad ME. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? J Am Assoc Gynecol Laparosc. 2003;10(2):172–6.

    Article  PubMed  Google Scholar 

  68. Al-Jabri S, Tulandi T. Management and prevention of pelvic adhesions. Semin Reprod Med. 2011;29(2):130–7.

    Article  PubMed  Google Scholar 

  69. Practice Committee of American Society for Reproductive Medicine in Collaboration with Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril. 2013;99(6):1550–5.

    Article  Google Scholar 

  70. Milingos S, Kallipolitis G, Loutradis D, Liapi A, Mavrommatis K, Drakakis P, et al. Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci. 2000;900:272–85.

    Article  CAS  PubMed  Google Scholar 

  71. Brokelman WJA, Holmdahl L, Bergström M, Falk P, Klinkenbijl JHG, Reijnen MMPJ. Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: a randomized trial. J Surg Res. 2006;136(2):309–13.

    Article  PubMed  Google Scholar 

  72. Binda MM, Molinas CR, Koninckx PR. Reactive oxygen species and adhesion formation: clinical implications in adhesion prevention. Hum Reprod. 2003;18(12):2503–7.

    Article  CAS  PubMed  Google Scholar 

  73. Yesildaglar N, Koninckx PR. Adhesion formation in intubated rabbits increases with high insufflation pressure during endoscopic surgery. Hum Reprod. 2000;15(3):687–91.

    Article  CAS  PubMed  Google Scholar 

  74. Molinas CR, Koninckx PR. Hypoxaemia induced by CO(2) or helium pneumoperitoneum is a co-factor in adhesion formation in rabbits. Hum Reprod. 2000;15(8):1758–63.

    Article  CAS  PubMed  Google Scholar 

  75. Malvasi A, Tinelli A, Farine D, Rahimi S, Cavallotti C, Vergara D, et al. Effects of visceral peritoneal closure on scar formation at cesarean delivery. Int J Gynaecol Obstet. 2009;105(2):131–5.

    Article  PubMed  Google Scholar 

  76. Franchi M, Ghezzi F, Zanaboni F, Scarabelli C, Beretta P, Donadello N. Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study. Obstet Gynecol. 1997;90(4 Pt 1):622–7.

    Article  CAS  PubMed  Google Scholar 

  77. Kadanali S, Erten O, Kücüközkan T. Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation. Eur J Surg Oncol. 1996;22(3):282–5.

    Article  CAS  PubMed  Google Scholar 

  78. Lyell DJ, Caughey AB, Hu E, Daniels K. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol. 2005;106(2):275–80.

    Article  PubMed  Google Scholar 

  79. Tulandi T. Salpingo-ovariolysis: a comparison between laser surgery and electrosurgery. Fertil Steril. 1986;45(4):489–91.

    CAS  PubMed  Google Scholar 

  80. Yaffe H, Reinhartz T, Laufer N, Beyth Y. Potentially deleterious effect of cornstarch glove powder in tubal reconstructive surgery. Fertil Steril. 1978;29(6):699–701.

    CAS  PubMed  Google Scholar 

  81. Wallwiener CW, Kraemer B, Wallwiener M, Brochhausen C, Isaacson KB, Rajab TK. The extent of adhesion induction through electrocoagulation and suturing in an experimental rat study. Fertil Steril. 2010;93(4):1040–4.

    Article  PubMed  Google Scholar 

  82. Bakkum EA, Dalmeijer RA, Verdel MJ, Hermans J, van Blitterswijk CA, Trimbos JB. Quantitative analysis of the inflammatory reaction surrounding sutures commonly used in operative procedures and the relation to postsurgical adhesion formation. Biomaterials. 1995;16(17):1283–9.

    Article  CAS  PubMed  Google Scholar 

  83. Schreinemacher MHF, van Barneveld KWY, Peeters E, Miserez M, Gijbels MJJ, Greve J-WM, et al. Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study. Hernia. 2014;18:865–72.

    Article  CAS  PubMed  Google Scholar 

  84. Turza KC, Butler CE. Adhesions and meshes: synthetic versus bioprosthetic. Plast Reconstr Surg. 2012;130(5 Suppl 2):206S–13.

    Article  CAS  PubMed  Google Scholar 

  85. Carbonnel M, Ducarme G, Dessapt A-L, Yazbeck C, Hugues J-N, Madelenat P, et al. Efficacy of transient abdominal ovariopexy in patients with severe endometriosis. Eur J Obstet Gynecol Reprod Biol. 2011;155(2):183–7.

    Article  PubMed  Google Scholar 

  86. Daraï E, Touboul C, Ballester M, Poncelet C. Can ovariopexy at the end of surgery for endometriosis be recommended? A case report. J Reprod Med. 2012;57(1–2):81–4.

    PubMed  Google Scholar 

  87. Poncelet C, Ducarme G, Yazbeck C, Madelenat P, Carbonnel M. Safety of transient abdominal ovariopexy in patients with severe endometriosis. Int J Gynaecol Obstet. 2012;118(2):120–2.

    Article  PubMed  Google Scholar 

  88. RCOG Scientific Impact Paper No. 39. The use of adhesion prevention agents in obstetrics and gynaecology. Royal College of Obstetricians and Gynaecologists. 2013. Available from http://www.rcog.org.uk/files/rcog-corp/5.6.13SIP39Adhesions.pdf.

  89. Jansen RP. Failure of peritoneal irrigation with heparin during pelvic operations upon young women to reduce adhesions. Surg Gynecol Obstet. 1988;166(2):154–60.

    CAS  PubMed  Google Scholar 

  90. Jansen RP. Controlled clinical approaches to investigating the prevention of peritoneal adhesions. Prog Clin Biol Res. 1990;358:177–92.

    CAS  PubMed  Google Scholar 

  91. Querleu D, Vankeerberghen-Deffense F, Boutteville C. Adjuvant treatment of tubal surgery. Randomized prospective study of systemically administered corticoids and noxythiolin. J Gynecol Obstet Biol Reprod (Paris). 1989;18(7):935–40.

    CAS  Google Scholar 

  92. Wiseman DM, Trout JR, Diamond MP. The rates of adhesion development and the effects of crystalloid solutions on adhesion development in pelvic surgery. Fertil Steril. 1998;70(4):702–11.

    Article  CAS  PubMed  Google Scholar 

  93. Hosie K, Gilbert JA, Kerr D, Brown CB, Peers EM. Fluid dynamics in man of an intraperitoneal drug delivery solution: 4 % icodextrin. Drug Deliv. 2001;8(1):9–12.

    Article  CAS  PubMed  Google Scholar 

  94. di Zerega GS, Verco SJS, Young P, Kettel M, Kobak W, Martin D, et al. A randomized, controlled pilot study of the safety and efficacy of 4 % icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery. Hum Reprod. 2002;17(4):1031–8.

    Article  Google Scholar 

  95. Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, DiZerega GS. Adept (icodextrin 4 % solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril. 2007;88(5):1413–26.

    Article  PubMed  Google Scholar 

  96. Pellicano M, Bramante S, Cirillo D, Palomba S, Bifulco G, Zullo F, et al. Effectiveness of autocrosslinked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study. Fertil Steril. 2003;80(2):441–4.

    Article  PubMed  Google Scholar 

  97. Lundorff P, van Geldorp H, Tronstad SE, Lalos O, Larsson B, Johns DB, et al. Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study. Hum Reprod. 2001;16(9):1982–8.

    Article  CAS  PubMed  Google Scholar 

  98. Diamond MP. Reduction of de novo postsurgical adhesions by intraoperative precoating with Sepracoat (HAL-C) solution: a prospective, randomized, blinded, placebo-controlled multicenter study. The Sepracoat Adhesion Study Group. Fertil Steril. 1998;69(6):1067–74.

    Article  CAS  PubMed  Google Scholar 

  99. Mais V, Cirronis MG, Peiretti M, Ferrucci G, Cossu E, Melis GB. Efficacy of auto-crosslinked hyaluronan gel for adhesion prevention in laparoscopy and hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  100. Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009;(1):CD005080.

    Google Scholar 

  101. Ten Broek RPG, Kok-Krant N, Verhoeve HR, van Goor H, Bakkum EA. Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery: Results of a randomized controlled pilot study. Gynecol Surg. 2012;9(1):29–35.

    Article  PubMed Central  PubMed  Google Scholar 

  102. Korell M. Reduction of adhesion by INTERCEED Barrier and Gortex Surgical Membrane after laparoscopic myomectomy. Presented at “Moglichkeiten der Adhasionprophylaxe”, Munich, 1994.

    Google Scholar 

  103. Haney AF, Hesla J, Hurst BS, Kettel LM, Murphy AA, Rock JA, et al. Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7+) in preventing adhesions. Fertil Steril. 1995;63(5):1021–6.

    CAS  PubMed  Google Scholar 

  104. Albright CM, Rouse DJ. Adhesion barriers at cesarean delivery: advertising compared with the evidence. Obstet Gynecol. 2011;118(1):157–60.

    Article  PubMed  Google Scholar 

  105. Cheong Y, Sadek K, Watson A, Metwally M, Li TC. Adhesion reduction agents in gynaecological procedures: can NHS afford it? An economic cost efficiency analysis. J Obstet Gynaecol. 2011;31(7):631–5.

    Article  CAS  PubMed  Google Scholar 

  106. Schreinemacher MHF, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg. 2010;34(12):2805–12.

    Article  PubMed Central  PubMed  Google Scholar 

  107. Ellis H. Medicolegal consequences of adhesions. Hosp Med. 2004;65(6):348–50.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Pennine Acute Hospitals NHS Trust, Oldham, Manchester, UK

    David Alexander Iles BSc (Med Sci), MBChB, MRCOG & Gaity Ahmad MBBS, MD, MRCOG

  2. Department of Obstetrics and Gynecology, Tameside Foundation Trust, Lancaster, UK

    Andrew Watson FRCOG

Authors
  1. David Alexander Iles BSc (Med Sci), MBChB, MRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaity Ahmad MBBS, MD, MRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Watson FRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Alexander Iles BSc (Med Sci), MBChB, MRCOG .

Editor information

Editors and Affiliations

  1. Reproductive Medicine and Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom

    Mostafa Metwally

  2. Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China

    Tin-Chiu Li

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Iles, D.A., Ahmad, G., Watson, A. (2015). Adhesions: Effects on Fertility and Prevention. In: Metwally, M., Li, TC. (eds) Reproductive Surgery in Assisted Conception. Springer, London. https://doi.org/10.1007/978-1-4471-4953-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4953-8_16

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4952-1

  • Online ISBN: 978-1-4471-4953-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation