[Adhesions and chronic pelvic pain]

Abstract

Objectives: To analyse pathophysiology of adhesions and their link with chronic pelvic pain, as well as therapeutic and prevention options as reported in the literature.

Material and methods: Review of articles and consensus conferences published on this topic in the Medline (Pubmed) database, selected according to their scientific relevance.

Results: Postoperative adhesions are responsible for a specific morbidity combining chronic pain, small bowel obstruction, infertility, and morbidity increase in the event of subsequent surgery. Chronic pains in previously operated on patients can be linked to postoperative adhesions. Ultrasonography and dynamic MRI can recognize intra abdominal adhesions, but cannot definitely link them to the painful symptoms. The prevention of adhesions is done firstly by respecting surgical rules concerning laparoscopic and open surgical approaches, and secondly by the use of anti-adhesion products. Pharmacological adhesion prevention systems decrease the frequency and extent of adhesions. Their efficiency has been proved by studies with substantial evidence levels. Patients suffering from potentially adhesion-induced chronic abdominal and pelvic pains can benefit from a laparoscopic adhesiolysis, which improved pain symptoms in more than 50% of patients, but exposes to the risk of complications, such as bowel injury.

Conclusion: The decision to perform adhesiolysis should be taken for each patient individually, while taking in consideration the benefit-to-risk ratio. Adhesion relapse after adhesiolysis is a frequent phenomenon, but can be reduced by the use of anti-adhesion products.