Chapter 73: PEARS for Extensive Pelvic Adhesive Disease

Hilgers TW

Reproductive Surgery Adhesion Prevention

Chapter 73: PEARS for Extensive Pelvic Adhesive Disease

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 1001-1012, 2004

RRM Academy Synopsis

PEARS surgery freed one woman's tubes and ovaries from adhesions

In one 30-year-old woman, PEARS surgery cleared extensive pelvic adhesions, shown step by step in a NaProTECHNOLOGY textbook chapter. At second-look surgery 10 days later, her tubes and ovaries were free of adhesions. The chapter reports that her pain improved markedly.

Key Findings

The woman was 30, with one child, one earlier miscarriage, severe pain at ovulation and pain with intercourse. Laparoscopy found the cul-de-sac completely obliterated and both tubes and ovaries encapsulated in adhesions.
At laparotomy the surgeons divided and excised the adhesions with microcautery, repaired the tissue defects with sutures, and reopened the fimbriated end of each tube with a cuff fimbrioplasty.
The surgeons covered the tubes with one adhesion barrier and the uterus, tubes and ovaries with a second, a Gore-Tex membrane. Second-look laparoscopy removed the membrane 10 days later.
At second look the tubes and ovaries were free and mobile, the cul-de-sac was open, and dye passed freely through both tubes. Final pathology showed extensive pelvic adhesions and endometriosis.
The woman stayed in hospital three days. The chapter describes her pain as remarkably improved and her fertility potential as restored.

RRM Context

PEARS is the surgical approach within NaProTECHNOLOGY. The chapter treats adhesion surgery as two jobs: excise the disease to restore normal anatomy, then protect the raw surfaces so new scar bands cannot form. Restorative surgery of this kind reopens the tubes and frees the ovaries where they lie. IVF bypasses the tubes and leaves the pelvic disease in place.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes the PEARS approach to extensive pelvic adhesive disease, which the chapter associates most commonly with extensive endometriosis, previous pelvic inflammatory disease, a previous ruptured appendix and previous pelvic surgery. The stated goal is to remove all of the adhesions, repair each tissue to approximate normal anatomy, and do so in a way that does not form subsequent adhesions. The technique is illustrated with a single case in which the adhesions were excised with microcautery at laparotomy, both fallopian tubes received a cuff fimbrioplasty, and peritoneal defects were closed with an imbricating 4-0 Prolene suture. The tissues were covered with Interceed and a Gore-Tex membrane, which was removed at a second-look laparoscopy 10 days later that showed the tubes and ovaries free of adhesions, and the chapter reports that the patient's pain was remarkably improved.

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Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

Reproductive Surgery › Adhesion Prevention › Surgical Technique and Adhesions · Infertility › Tubal Factor › Distal Tubal Disease

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 73: PEARS for Extensive Pelvic Adhesive Disease

PEARS surgery freed one woman's tubes and ovaries from adhesions

Key Findings

RRM Context

Abstract

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