Dr. Diamond {continued}

Offering Hope and Help to the Victims of ARD Worldwide

Adhesion Rate

Initial Surgery(1)

Follow-Up Laparscopy (within 12 Weeks)

Tissue	No.	%	No.	%
Ovaries	303/387	78	207/376	55
Fimbria	244/384	64	135/372	36
Cul-de-sac	87/208	42	42/208	20
Omentum	32/208	15	39/208	19
Colon	63/208	30	30/204	15
Small intestine	30/208	14	30/208	14
Pelvic Sidewall	124/208	60	84/208	40

1. Initial surgery performed using CO2 laser plus 35% dextran 70 or nonlaser surgical technique with or without dextran. Results are pooled over three initial surgical procedure groups.
Adapted from Diamond MP. Surgical aspects of infertility. In: Gynecology and Obstetrics, 1991.

Adhesions are common and can form on any surface in the pelvis and abdomen after surgery. However, some organs are more likely to develop adhesions than others. Diamond et al reported that the ovary, pelvic sidewall, and fimbria are the most common sites for adhesion formation. In fact, they found that more than one half of patients developed adhesions to an ovary following surgery. The incidence of adhesion formation following surgery to the pelvic sidewall and fimbria was 40% and 36%, respectively.

Reference:
1. Diamond MP. Surgical aspects of infertility. In: Sciarra JJ, Simpson JL, Speroff L, eds. Gynecology and Obstetrics. Philadelphia, Pa: JB Lippincott Co; 1991;5:1-23.

Total Adhesion

Author	No.	(%)	Notes
Nemir (1952)	430	33
Perry et al. (1955)	1252	31
Raf (1969)	2295	64	Small intestine only
Playforth et al. (1970)	111	54	Small intestine only
Stewardson et al. (1978)	238	64	Small intestine only
Ellis (1982)	253	26	Adults

Ellis, Br J Surg.69:241.

As mentioned earlier, bowel obstruction is often associated with adhesions. These studies found a 26% to 64% incidence of adhesions causing bowel obstruction.

References:
1. Ellis H. Causes and prevention of intestinal adhesions. Br J Surg. 1982;69:241-243.

Adhesion Prevention - Incidence of Adhesions Slide 1

	Time From Initial Procedure	Total No. of Patients	Percentage With Adhesions
Diamond et al	1 wk - 12 wk	106	86
De Cherney and Mezer	4 wk - 16 wk	20	75
	1 y - 3 y	41	76
Surrey and Friedman	6 wk - 8 wk	31	71
	> 6 mo	6	83
Pittaway et al	4 wk - 6 wk	23	100
Trimbos-Kempor et al	8 d	188	55
Daniell and Pittaway	4 wk - 6 wk	25	96

Adapted from Diamond MP. Surgical aspects of infertility. In: Gynecology and Obstetrics, 1988.

The incidence of pelvic adhesions varies following reconstructive surgery. This slide provides an overview of the studies reviewed by Diamond. Diamond et al noted an 86% incidence of pelvic adhesions at second-look laparoscopy after reconstructive pelvic surgery. DeCherney and Mezer observed a 75% incidence of adhesions after the initial procedures at 4 to 16 weeks.
Surrey and Friedman noted a 71% incidence of adhesion formation. When a subset of these patients were studied long-term, 83% of them had adhesions. Pittaway et al found that all 23 of their patients had adhesions. Trimbos-Kemper et al observed adhesions in 55% of their patients. Finally, Daniell and Pittaway noted adhesion formation in 96% of women at second-look laparoscopy following reconstructive surgery.
It is important to note that the adhesions seen in these studies represent not only adhesion reformation, but de novo adhesion formation as well.
Reference:
1. Diamond MP. Surgical aspects of infertility. In: Sciarra JW, ed. Gynecology and Obstetrics. Philadelphia, Pa: Harper & Row; 1988;5:chap 61.

Michael P. Diamond, MD
Click here to Continue

home ||Vicims of Adhesions stories|| ARD Site Index||
Bev's Mission for ARD ||Contact Us ||Links||ARD News Page

The information provided in this site is not intended nor is it implied to substitute any professional medical advice and services. Please seek the advice of your physician or other qualified health provider when starting any new medical intervention or with any questions you may have regarding your medical condition. State laws prohibit the practice of telemedicine without licensure in each state.
This Internet site provides links or references to other sites that are provided as a convenience to users of this site.
Adhesionrelateddisorder.com has no control over the content of such other sites and shall not be liable for any damages or injury arising from that content.