Chapter 81: Preventing Pelvic Adhesions

Hilgers TW

Reproductive Surgery Adhesion Prevention

Chapter 81: Preventing Pelvic Adhesions

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 1083-1086, 2004

RRM Academy Synopsis

Severe pelvic adhesion scores fell after surgical NaProTECHNOLOGY

In patients with severe pelvic adhesive disease, adhesion scores fell after surgical NaProTECHNOLOGY and were lower in the later group, which used Gore-Tex membrane. A 2004 textbook chapter compares patients operated on from 1985 to 1993 with those operated on from 1994 to 2004. Both groups had second-look laparoscopy.

Key Findings

The chapter reports experience suggesting that extensive operative laparoscopy is associated with significant pelvic adhesion formation, mostly related to technique that leaves the ovarian capsule and uterine serosa unclosed.
Patients with severe pelvic adhesive disease operated on from 1985 through 1993 with basic NaProTECHNOLOGY anti-adhesion techniques had a significantly lower total adhesion score at second-look laparoscopy than at initial surgery.
The group operated on from 1994 through 2004 began with a similar total adhesion score and ended significantly lower than the earlier group, in the American Fertility Society minimal range.
Scores stayed low after laser laparoscopy and fell after laser laparotomy in a small group, with neither change significant; the author says the laparotomy surgery added no adhesions.
The author concludes that surgical NaProTECHNOLOGY allows major procedures to remove existing adhesions and likely reduces or eliminates their reformation when anti-adhesion technique is followed.

RRM Context

Surgical NaProTECHNOLOGY, developed by Dr. Thomas W. Hilgers, builds adhesion prevention into the operation itself. Restorative reproductive medicine aims to return the pelvis to normal anatomy and function, so the state of the tissue after surgery is part of the result. Second-look laparoscopy lets surgeons see that result directly, and the chapter uses it to score adhesions in successive groups of patients. Restorative surgery for endometriosis treats the disease and protects nearby reproductive organs within a single operation, with the aim of preserving their reproductive function.

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

Abstract

This chapter reports adhesion scores at second-look laparoscopy after surgical NaProTECHNOLOGY at the Pope Paul VI Institute, after stating that the Institute's experience suggests extensive operative laparoscopy is associated with significant formation of pelvic adhesions. In patients with severe pelvic adhesive disease operated on from 1985 through 1993 with basic NaProTECHNOLOGY anti-adhesion techniques, the total adhesion score fell from 33.8 at surgery to 18.1 at second-look laparoscopy (p<.001). After more extensive use of Gore-Tex was introduced, a later group fell from a total adhesion score of 33.3 to 6.0 (p<.0001), a score the chapter describes as minimal adhesions. For laser laparoscopy and for laser laparotomy without Gore-Tex, the changes in adhesion scores at second-look laparoscopy were not statistically significant, and the chapter states that the surgery itself did not cause additional adhesions.

Read the guide

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

Topics

Reproductive Surgery Adhesion Prevention Surgical Technique and Adhesions

Reproductive Surgery › Adhesion Prevention › Surgical Technique and Adhesions

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 81: Preventing Pelvic Adhesions

Severe pelvic adhesion scores fell after surgical NaProTECHNOLOGY

Key Findings

RRM Context

Abstract

Read the guide

Topics

By this author

Related research