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Treatment of pain caused by abdominal and pelvic adhesions is possibly one of the most controversial issues among physicians taking care of patients with pelvic pain, and science is not helpful. There are publications that show that adhesions do not cause pain and others that show they do. The same goes for usefulness of adhesiolysis to relieve that pain. This discrepancy may be due to the fact that some surgeons preform more complete adhesiolysis than others and that coexisting pain conditions may be an additional confounding factor. I believe that certain adhesions cause pain and, in many cases, adhesiolysis is helpful. Laparoscopic or robotic adhesiolysis is a preferred way because chances of recurrence of adhesions is decreased. This may be due to the fact that CO2 prevents fibroblast migration. Risks of adhesiolyis including a risk of unrecognized bowel injury have to be very clearly explained to the patient and this procedure should be performed only by a skilled surgeon.
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