Adhesions

Adhesions (Laparoscopic image)

Image 1. Adhesions (Laparoscopic image).

Adhesions may be a cause of subfertility (tubal-peritoneal aetiology) and probably pelvic pain. It is possible to affect one or more organs of the pelvis and they are usually located between the uterus, the fallopian tubes, the ovaries, the peritoneum, the intestine, the vermiform appendix and the omentum. Usual aetiology includes pre-existed inflammation and procedures in the pelvic area.

VIDEO Fitz-Curtis-Hugh syndrome. The right hypochondriac region can be observed with "violin-string" adhesions.
Extended pelvic adhesions, a result of severe inflammation (laparoscopic image).

Image 2. – Extended pelvic adhesions, a result of severe inflammation (laparoscopic image).

Adhesions may be thin transparent and avascular (Image 1.) and solid and fibrous ones (Image 2.) that usually contain blood vessels.

The thin and transparent adhesions may easily be lysed with laser CO2 (Image 3.), while solid and fibrous ones that sometimes permeate all the organs in the pelvis and alter completely the anatomical relations, need more attention and experience.

Pregnancy rates after laser laparoscopic lysis of the adhesions are estimated around 55% according to some studies.

Image 3
A: The thin and transparent adhesions can easily be removed with laser CO2.
Β: The lysis of extended adhesions demands great experience and surgical time.
C: Following the lysis of the thin adhesion of the ovary the removal of Image B adhesions is completed. The normal relations between the organs have been restored (laparoscopic image).

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