Skip to main content Accessibility help
×
Hostname: page-component-77f85d65b8-g4pgd Total loading time: 0 Render date: 2026-04-17T03:56:34.945Z Has data issue: false hasContentIssue false

Chapter 12 - Video Laparoscopic Adhesiolysis and Adhesion Prevention

Published online by Cambridge University Press:  06 November 2025

By
Danielle Luciano  and
Anthony Luciano
Edited by
Camran R. Nezhat ,
Farr R. Nezhat ,
Ceana Nezhat ,
Nisha Lakhi  and
Azadeh Nezhat
Camran R. Nezhat
Affiliation:
Stanford University School of Medicine, California
Farr R. Nezhat
Affiliation:
Nezhat Surgery for Gynecology/Oncology, New York
Ceana Nezhat
Affiliation:
Nezhat Medical Center, Atlanta
Nisha Lakhi
Affiliation:
Richmond University Medical Center, New York
Azadeh Nezhat
Affiliation:
Nezhat Institute and Center for Special Minimally Invasive and Robotic Surgery, California
Get access

Summary

Adhesions are a known postoperative complication of gynecologic surgery occurring in 75–90% of patients following surgery. Adhesions can cause bowel obstruction, pain, infertility, and difficulty with the next surgery. Adhesions are formed as a physiologic healing response to tissue injury. Currently, despite research and the availability of multiple adhesion barriers, adhesions remain a persistent problem. The American Society for Reproductive Medicine (ASRM), along with many other international medical societies, recommends that efforts to minimize adhesion formation should be utilized including minimally invasive techniques and surgical barriers when performing pelvic surgery.

Information

Type
Chapter
Information
Nezhat's Textbook of Minimally Invasive Surgery
Including Hysteroscopy, Vaginoscopy and Robotic-Assisted Procedures
 , pp. 358 - 362
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Practice Committee of the American Society for Reproductive Medicine. Control and prevention of peritoneal adhesions in gynecologic surgery. Fert Steril 2006;86(4):S1–S5.CrossRefGoogle Scholar
Kligman, I. Immunohistochemical demonstration of nerve fibers in pelvic adhesions. Obstet Gynecol 1993;82(4):566–568.Google ScholarPubMed
Howard, FM . The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol 2000;14:467–494.CrossRefGoogle ScholarPubMed
Steege, JF. Resolution of chronic pelvic pain after laparoscopic adhesiolysis. Am J Obset Gynecol 1991;165(2):278–281.CrossRefGoogle Scholar
Swank, DJ, Swank-Bordewijk, SC, Hop, WC. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomized controlled multicenter trial. Lancet 2003;361:1247–1251.CrossRefGoogle Scholar
Luciano, AA, Marana, R, Kratka, A, et al. Ovarian function after incision of the ovary by scalpel, CO2 laser and microelectrode. Fertil Steril 1991:56:349.CrossRefGoogle ScholarPubMed
Stovall, TG, Elder, RF, Ling, FW. Predictors of pelvic adhesions. J Reprod Med 1989;34:345–348.Google ScholarPubMed
Davey, AK, Maher, PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invas Surg 2007;14(1):15–22.Google ScholarPubMed
Morales, K, Gordon, M, Bates, GW. Post cesarean adhesions may compromise infant well-being (abst. no. 18). American College of Obstetricians and Gynecologists Armed Forces District Meeting, Nov 2, 2005.Google Scholar
Swank, DJ, Van Erp, WF, Repelaer Van Driel, OJ. A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Laparosc Endosc Percutan Tech 2003;13:88–94.CrossRefGoogle ScholarPubMed
Awonuga, AO, Saed, GM, Diamond, MP. Laparoscopy in gynecologic surgery: adhesion development, prevention, and use of adjunctive therapies. Clin Obstet Gyncol 2009;52(3):412–442.CrossRefGoogle ScholarPubMed
Al-Sunaidi, M, Tulandi, T. Adhesion- related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol 2006;108(5):1162–1166.CrossRefGoogle ScholarPubMed
Brochhausen, C, Schmitt, AH, Rejab, TK, et al. Intraperitoneal adhesions – an ongoing challenge between biomedical engineering and the life sciences. J Biomed Mater Res A 2011;98:143–156.CrossRefGoogle ScholarPubMed
Bruggmann, D, Tchartchian, G, Wallwiener, M, et al. Intra-abdominal adhesions, definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int 2010;107(44):769–775.Google ScholarPubMed
Luciano, DE, Roy, G, Luciano, AA. Adhesion reformation after laparoscopic adhesiolysis: where, what type, and in whom they are most likely to recur. J Minim Invas Surg 2008;15:44–48.Google ScholarPubMed
Nezhat, CH, Dun, EC, Katz, A, Wieser, FA. Office visceral slide test compared with two perioperative tests for predicting periumbilical adhesions. Obstet Gynecol 2014;123(5):1049–1056.CrossRefGoogle ScholarPubMed
Guerriero, S, Condous, G, van den Bosch, T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound in Obstet Gynecol 2016;48(3):318–332.CrossRefGoogle ScholarPubMed
Gomel, V, Koninckx, PR. Microsurgical principles and postoperative adhesions: lessons from the past. Fertil Ster 2016:106(5):1025–1031.CrossRefGoogle ScholarPubMed
Luciano, AA, Montanino-Oliva, M. Comparison of postoperative adhesion formation laparoscopy versus laparotomy. Infertil Reprod Med Clinics N Am 1994;5(3):437–444.Google Scholar
Luciano, AA, Maier, DB, Nulsen, JC, et al. A comparative study of postoperative adhesion formation following laser surgery by laparoscopy versus laparotomy in the rabbit model. Obstet Gynecol 1989;74:220–224.Google ScholarPubMed
Peng, Y, Zheng, M, Ye, Q, et al. Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intraoperative adhesions during prolonged laparoscopic insufflations. J Surg Res 2009;151:40–47.CrossRefGoogle Scholar
Robertson, D, Lefebvre, G. Society of Obstetrics and Gynecology Canada Clinical Practice Guidelines: adhesion prevention in gynaecological surgery. J Obstet Gynecol Can 2010;243: 598–602.CrossRefGoogle Scholar
DeCherney, AH, diZerega, GS. Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin N Am 1997;77:671–688.CrossRefGoogle ScholarPubMed
Ahmed, G, Duffy, JM, Farquhar, C, et al. Barrier agents for adhesion prevention after gynecological surgery. Cochrane Database Syst Rev 2008;2:CD000475.Google Scholar
Fenton, BW, Fanning, J. Laparoscopic application of hyaluronate/ carboxymethylcellulose slurry: an adhesion barrier in a slurry formation goes where the available sheet cannot. Am J Obstet Gynecol 2008;199(3):325e1.CrossRefGoogle Scholar
Brown, CB, Luciano, AA, Martin, D, et al. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fert Steril 2007;88:1413–1426.CrossRefGoogle ScholarPubMed
Baxter Healthcare Corporation. Adept Adhesion Reduction Solution (4% icodextrin). Information for prescribers. 2006.Google Scholar
Mettler, L, Audebert, A, Lehmann- Willenbrock, E, et al. A randomized, prospective, controlled, multicenter clinical trial of a sprayable, site specific adhesion barrier system in patients undergoing myomectomy. Fertil Steril 2004;82:398–404.CrossRefGoogle ScholarPubMed
Trew, GH, Pistofidis, G, Pados, G, et al. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicenter, double blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011;26:2015–2027.CrossRefGoogle Scholar
Young, P, Johns, A, Templemann, C. Reduction of postoperative adhesions after laparoscopic gynecological surgery with Oxiplex/APGel: a pilot study. Fertil Steril 2005:84:1450–1456.CrossRefGoogle Scholar
Lundorff, P, Donnez, J, Korell, M. Clinical evaluation of a viscoelastic gel for reduction of adhesions following gynecological surgery by laparoscopy in Europe. Hum Reprod 2005;20:514–520.CrossRefGoogle ScholarPubMed
Farag, S, Frazzini Padilla, P, Smith, KA, Sprague, ML, Zimberg, SE. Management, prevention, and sequelae of adhesions in women undergoing laparoscopic gynecologic surgery: a systematic review. JMIG 2017;25(7):1194–1215.Google ScholarPubMed

Accessibility standard: WCAG 2.0 A

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

The HTML of this chapter conforms to version 2.0 of the Web Content Accessibility Guidelines (WCAG), ensuring core accessibility principles are addressed and meets the basic (A) level of WCAG compliance, addressing essential accessibility barriers.

Content Navigation

Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Index navigation
Provides an interactive index, letting you go straight to where a term or subject appears in the text without manual searching.

Reading Order & Textual Equivalents

Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.

Visual Accessibility

Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.

Structural and Technical Features

ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×