Adhesions are defined as connections between opposing serosal and/or nonserosal surfaces of the internal organs and the abdominal wall, at sites where there should be no connection. This connection can be a band, which is vascular or avascular, and filmy/transparent or dense/opaque, or it could be a cohesive connection of surfaces without an intervening adhesion band. Adhesion formation is an almost unavoidable consequence of abdominal surgery. Although not all patients with intra-abdominal adhesions develop symptoms, the clinical implications, such as early and late bowel obstruction, infertility, and chronic abdominal pain, remain a common problem in general surgical and gynecologic practice. In addition, adhesion formation is associated with increased socioeconomic costs.

THE RISK FACTORS AND CLINICAL SIGNIFICANCE OF ADHESIONS

The risk factors for pelvic adhesions include a history of pelvic inflammatory disease (PID), prior surgery, perforated appendix, endometriosis, and inflammatory bowel diseases. Other recognized causes of adhesions include bacterial peritonitis, radiotherapy, chemical peritonitis, foreign body reaction, long-term continuous ambulatory peritoneal dialysis, endometriosis, and pelvic inflammatory disease. However, the greatest contribution of these risk factors is a previous history of an intra-abdominal operative procedure.

Adhesion formation after abdominal and pelvic operations remains extremely common and is a source of considerable morbidity. Menzies and Ellis confirmed that after an intra-abdominal operation, most patients developed adhesions.

Retropubic Burch colposuspension has been considered by many to be the “gold standard” procedure for the treatment of female stress urinary incontinence for almost 40 years. Vancaillie and Schuessler introduced the laparoscopic approach to retropubic colposuspension in 1991. Numerous reports followed in subsequent years describing laparoscopic colposuspensions and their efficacy. Analysis of the outcomes of these various laparoscopic “Burch” colposuspensions is difficult because many of the techniques are not true Burch procedures but rather other modified retropubic colposuspensions. In this section, we describe the laparoscopic Burch colposuspension, including patient selection, preoperative evaluation, operative technique, possible complications, and efficacy. We review the efficacy of the laparoscopic Burch colposuspension studies that use the Burch—Tanagho procedure and compare these techniques to other popular anti-incontinence procedures. The many modified laparoscopic retropubic procedures are not addressed.

BURCH COLPOSUSPENSION: THE EVOLUTION OF A PROCEDURE

In 1961, Burch published the description of a new female anti-incontinence procedure, based on a technique started in 1958. The technique involved entering the space of Retzius via a paramedian incision. After clearing the periurethral tissue of its overlying fat and areolar tissue, three 2-0 chromic sutures were placed at the mid-urethra and the bladder neck and then fixed to Cooper's ligament. Burch reported a subjective cure rate of 92% in 143 patients with 10 to 60 months of followup.