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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

 

Adhesions / Scar

Up Filmy Adhesions Dense Adhesions

Adhesions and scar are often used interchangeably.  Adhesions are often used to describe thin or stretched scar.  This can also be used for thick scar.  Scar after surgery is similar in both your pelvis and on your hand.  Scar's purpose is to hold your body together.  Scar starts forming immediately.  On your hand it is usually able to hold skin together within a few days.  This also happens in the pelvis.  This is normal.

Scarring after surgery is similar in both the pelvis and your  hand.  Scar's purpose is to hold the body together.  Scar starts forming immediately.  On your hand it is able to hold skin together within a few days.  This also happens in the pelvis.  This is normal when it holds two parts together that are supposed to be together.  It is abnormal when it it holds the wrong areas together.  On a hand, this can cause an unusual appearance.  As an example in the pelvis, the tubes can scar to the ovaries or internal skin lining (peritoneum).  Dr. Ellis, about 1950, called excessive adhesions in the abdomen "internal overhealing."   This means the body is doing too much in trying to heal.  Problems may be due to normal healing, too many adhesions or adhesions pulling the wrong areas together. 

Some terms on skin have similar terms in the pelvis.  When the scar is thick on skin, it is called a keloid.  This is called fibrosis in the pelvis.  Other pelvic terms may have no corresponding skin term. 

Scars on skin can cause pain from a few minutes to several years.  The same can be true in the pelvis.  Your pain may disappear soon or may take several years.  Additional surgery, acupuncture, massage, biofeedback or other treatment may be useful for relief of pain.

Adhesions can also cause problems with fertility.  These can cause scarring in the pelvis or on the tubes.  Tubal scars can partially block the tube (phimosis) or completely block the tube (hydrosalpinx or cornual occlusion) Although adhesions can be removed at surgery, surgery can also cause adhesions.  The more damage there is during surgery, the greater the chance that adhesions will occur.  Damage to the tubes also increases the chance of tubal pregnancy.

Adhesions can be diagnosed and directly treated by surgery.  Indirect treatment includes acupuncture, message, stress therapy, pain medication and other non-specific treatment.  When surgery is used, laparoscopy (belly-button surgery) may decrease the chance of getting new adhesions when compared to laparotomy (open surgery).  However, both of these have about the same chance of having of old adhesions. Lasers at laparoscopy were originally felt to add to this to a greater extent but the major advantage of lasers was that they were used at laparoscopy.  Equipment other than lasers have the same effect.

Some surgical techniques are thought to decrease adhesions.  Those techniques avoid damaging to blood vessels, decrease drying, avoid using sutures, control crushing with instruments and limiting infection.  These techniques can include laparoscopy that uses air to move tissue, fluid solutions to keep tissues wet and antibiotics to avoid infection.

Specialized material is often used at surgery to keep the tissue edges apart.  Permanent patches such as Gor-Tex® can be used when the two areas do not need to touch.  An example of this is the area between the ovary and lateral sidewall.  However, this will not work between the tube and ovary because that would stop egg transport.  In this area, a material such as Interceed® can be used in a temporary fashion.  Fluid solutions are also used which contain various components to help decrease the chance of adhesions.  All of these have some data to support them but none have uniform support by testing.

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