Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated May 7, 2026

Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS) is a surgical philosophy and protocol, developed by Dr. Thomas Hilgers, built on a single clinical observation: adhesion formation after pelvic surgery cannot be eliminated, but it can be minimized systematically.⁷⁸

NARPS is the framework. PEARS is the execution. Where PEARS describes a procedure applied to specific pathology, NARPS describes the set of more than ten anti-adhesion principles that govern every step of that procedure.

Those principles include: careful incision and dissection technique, Prolene imbricating closure with rough peritoneal edges inverted away from the peritoneal cavity, talc-free hydro-pack bowel isolation, heparinized Ringer's lactate irrigation, fibrin sealant or barrier placement, micro-monopolar or CO₂-laser excision, and meticulous hemostasis throughout.⁷⁸

The 2010 outcomes paper by Hilgers, Stanford, Boyle, and colleagues documented three distinct phases of protocol refinement over 23 years: Phase I (1987 to 1993, 26 patients), Phase II (1994 to 2005, 44 patients), and Phase III (2006 to 2009, 25 patients).⁸⁰ Postoperative AFS adhesion scores declined progressively across phases, from approximately 33.8 in Phase I to approximately 18 in Phase III. The data show measurable improvement with each iteration of the protocol.

For patients with the most extensive pelvic adhesive disease, NARPS represents the evidence base for expecting a near-adhesion-free postoperative outcome: not as a promise, but as a documented clinical target.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.