Pelvic Adhesions (Scar Tissue)

Pelvic adhesions are bands of scar tissue that form between organs in the pelvis and bind them together. They can follow surgery, infection, inflammation, or endometriosis. Organs that should glide freely become stuck. Adhesions can pull the tube and ovary out of place. They can block the egg from reaching the tube. They can also cause lasting pain.

Adhesions are common in women with a history of endometriosis, pelvic infection, or earlier abdominal surgery. They can occur after more than 90% of gynecologic surgeries.¹ They are often present in couples told they have unexplained infertility. Routine ultrasound usually misses them. An HSG, an X-ray dye test of the tubes, usually misses them as well. Laparoscopy shows them clearly.

The operation that treats them is adhesiolysis. The surgeon divides and removes the scar bands with fine tools under magnification. The goal is to return the tubes and ovaries to their normal position and free movement. Scar tissue can form again after surgery. The surgeon can place anti-adhesion barriers at the end of the operation. These sheets and gels hold raw surfaces apart while they heal.

Trials of these barriers are small and of low quality. Some barriers lowered how often scar tissue formed again. The trials did not report pain or live birth. The effect of barriers on those outcomes is still an open question.² Careful technique is the other half of the work. Surgery itself can create new scar tissue. For this reason, methods developed within Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS) limit injury to the peritoneum, the lining of the pelvis, at every step.³

Treating the cause of the scarring matters as much as clearing it. Where endometriosis is the cause, excision removes the disease rather than covering it.