Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions

Tulandi, Togas; Collins, John A.; Burrows, Elizabeth; Jarrell, John; McInnes, Robert A.; Wrixon, William; Simpson, Charles W.

doi:10.1016/0002-9378(90)90384-j

Cited by 135 publications

(60 citation statements)

References 5 publications

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“…Postoperative adhesion formation occurs in 93% to 100% of patients undergoing laparotomy, 1 leading to complications such as intestinal obstruction and infertility in women. [2][3][4] Adhesions have also been implicated as a cause of chronic abdominopelvic pain, [5][6][7][8] and many patients have been relieved of their symptoms after adhesiolysis. 9 -12 Chronic pelvic pain accounts for up to 25% of all gynecologic visits, 30% to 50% of all diagnostic laparoscopic procedures, and approximately 5% of hysterectomies.…”

Section: Discussionmentioning

confidence: 99%

Presence and Distribution of Sensory Nerve Fibers in Human Peritoneal Adhesions

Sulaiman¹,

Gabella²,

Davis³

et al. 2001

Annals of Surgery

131

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ObjectiveTo assess the distribution and type of nerve fibers present in human peritoneal adhesions and to relate data on location and size of nerves with estimated age and with clinical parameters such as reports of chronic pelvic pain. Summary Background DataPeritoneal adhesions are implicated in the cause of chronic abdominopelvic pain, and many patients are relieved of their symptoms after adhesiolysis. Adhesions are thought to cause pain indirectly by restricting organ motion, thus stretching and pulling smooth muscle of adjacent viscera or the abdominal wall. However, in mapping studies using microlaparoscopic techniques, 80% of patients with pelvic adhesions reported tenderness when these structures were probed, an observation suggesting that adhesions themselves are capable of generating pain stimuli. MethodsHuman peritoneal adhesions were collected from 25 patients undergoing laparotomy, 20 of whom reported chronic pelvic pain. Tissue samples were prepared for histologic, immunohistochemical, and ultrastructural analysis. Nerve fibers were characterized using antibodies against several neuronal markers, including those expressed by sensory nerve fibers. In addition, the distribution of nerve fibers, their orientation, and their association with blood vessels were investigated by acetylcholinesterase histochemistry and dual immunolocalization. ResultsNerve fibers, identified histologically, ultrastructurally, and immunohistochemically, were present in all the peritoneal adhesions examined. The location of the adhesion, its size, and its estimated age did not influence the type of nerve fibers found. Further, fibers expressing the sensory neuronal markers calcitonin gene-related protein and substance P were present in all adhesions irrespective of reports of chronic abdominopelvic pain. The nerves comprised both myelinated and nonmyelinated axons and were often, but not invariably, associated with blood vessels. ConclusionsThis study provides the first direct evidence for the presence of sensory nerve fibers in human peritoneal adhesions, suggesting that these structures may be capable of conducting pain after appropriate stimulation.Peritoneal adhesions are bands of fibrous tissue that join abdominal organs to each other or the abdominal wall. Adhesions develop rapidly after damage to the peritoneum during surgery, infection, trauma, or irradiation. Postoperative adhesion formation occurs in 93% to 100% of patients undergoing laparotomy, 1 leading to complications such as intestinal obstruction and infertility in women.2-4 Adhesions have also been implicated as a cause of chronic abdominopelvic pain, 5-8 and many patients have been relieved of their symptoms after adhesiolysis.9 -12 Chronic pelvic pain accounts for up to 25% of all gynecologic visits, 30% to 50% of all diagnostic laparoscopic procedures, and approximately 5% of hysterectomies. 13,14 In financial terms, the annual cost of resources for the diagnosis and treatment of women with chronic pelvic pain in the United Kingdom is approximately £600...

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Section: Discussionmentioning

confidence: 99%

Presence and Distribution of Sensory Nerve Fibers in Human Peritoneal Adhesions

Sulaiman¹,

Gabella²,

Davis³

et al. 2001

Annals of Surgery

131

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“…Open adhesiolysis has been shown to increase spontaneous pregnancy rates [25]. The cumulative pregnancy rates were higher at 12 and 24 months in the group that was treated as compared with those who were untreated.…”

Section: Resultsmentioning

confidence: 98%

Endoscopic procedures in ART: an overview

2004

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In the past two decades, improvement in instrumentation has lead to widespread use of gynaecological endoscopy. Most doctors involved in delivering infertility services have had some training and experience in gynaecological endoscopy. Laparoscopy is a commonly performed endoscopic procedure in the evaluation and management of the infertile couple. The economic and safety issues of diagnostic laparoscopy should be considered. Evidence suggests that laparoscopy has a role to play in evaluating women with unexplained infertility prior to ART. Infertility investigations and treatment are a long process. A one-stop approach has therefore been proposed for couples presenting with infertility. Transvaginal hydrolaparoscopy is systematically combined with mini-hysteroscopy, chrompertubation, fimbrioscopy and salpingoscopy, if needed. The combination of these procedures is referred to as "fertiloscopy". This approach has been shown to be feasible, accurate for determining tubal patency (95%), safer than laparoscopy with respect to bowel injuries, better tolerated and certainly costeffective.

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“…In women with infertility as a result of adnexal adhesions, pregnancy rates of 32 and 45% at 12 and 24 months respectively have been reported following adhesiolysis, compared with 11 and 16% at corresponding time intervals in untreated women [46]. A follow-up period of 3 years reported higher pregnancy rates in women who underwent tubal surgery compared with those who did not (29 vs 12%) Fig.…”

Section: Infertilitymentioning

confidence: 99%

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position

DeWilde

Trew

2007

Gynecol Surg

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Adhesions are the most frequent complication of abdominopelvic surgery, yet many surgeons are still not aware of the extent of the problem and its serious consequences. While adhesions may cause few or no detrimental effects to patients, in a considerable proportion of cases there are major short-and long-term consequences, including small-bowel obstruction, infertility and chronic pelvic pain. Adhesions complicate future surgery with important associated morbidity and expense-and a considerable risk of mortality. Despite advances in surgical techniques in recent years, the burden of adhesion-related complications has not changed. Adhesions should now be considered the most common complication of abdominopelvic surgery. Adhesiolysis remains the main treatment, despite the fact that adhesions reform in most patients. Developments in adhesion-reduction strategies and new agents now offer a realistic possibility of reducing the risk of adhesions forming and can improve the outcomes for patients and the associated onward burden. This consensus position represents the collective views of 35 gynaecologists with a recognised interest in adhesions. The position is presented in two parts. The first part reviews the published literature on the extent of the problem of adhesions, and the second part considers the opportunities to reduce their incidence. It also provides collective proposals on the actions that European gynaecologists should take to avoid causing adhesions. Importantly it also advises that it is now time to inform patients of the risks associated with adhesion-related complications during the consent process. With increasing evidence to support the efficacy of adhesion-reduction agents to complement good surgical practice, all surgeons should act now to reduce adhesions and fulfil their duty of care to patients.

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Treatment-dependent and treatment-independent pregnancy among women with periadnexal adhesions

Cited by 135 publications

References 5 publications

Presence and Distribution of Sensory Nerve Fibers in Human Peritoneal Adhesions

Presence and Distribution of Sensory Nerve Fibers in Human Peritoneal Adhesions

Endoscopic procedures in ART: an overview

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position

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