Most gynecologic procedures performed in the peritoneal cavity lead to the formation of adhesions. The incidence rates shown on this slide were confirmed through clinical studies involving both laparotomy and laparoscopic techniques. The ovary appears to be the most common site for adhesion formation regardless of which surgical technique is used. In the Mais study on adhesion formation following laparoscopic myomectomy, the ovary was the most common attachment site. However, it is important to note that while laparoscopic surgery does reduce ancillary de novo adhesions (possibly because of the reduced handling of tissues), the incidence of reformed adhesions with laparoscopy is the same as with laparotomy. 

References:
INTERCEED* (TC7) Absorbable Adhesion Barrier Study Group. Prevention of postsurgical adhesions by INTERCEED Barrier, an absorbable adhesion barrier: a prospective, randomized multicenter clinical study. Fertil Steril. 1989;51:933-938. 
Sekiba K and the Obstetrics and Gynecology Adhesion Prevention Committee. Use of INTERCEED (TC7) Absorbable Adhesion Barrier to reduce postoperative adhesion reformation in infertility and endometriosis surgery. Obstet Gynecol. 1992;79:518-522. 
Diamond MP et al for the Operative Laparoscopy Study Group. Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertil Steril. 1991;55:700-704. 
Lundorff P, Thorburn J, Lindblum B. Second-look laparoscopy after ectopic pregnancy. Fertil Steril. 1990;53:604-609. 
Lundorff P, Hahlin M, Kallfelt B, et al. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril. 1991;55:911-915. 
Diamond MP. Surgical aspects of infertility. In: Sciarra JJ, Simpson JL, Speroff L, eds. Gynecology and Obstetrics. Philadephia, Pa: JB Lippincott Co; 1991;5:1-23. 
Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol. 1993;82:213-215. 
Gehlbach DL, Sousa RC, Carpenter SE, et al. Abdominal myomectomy in the treatment of infertility. Int J Gynecol Obstet. 1993;40:45-50. 
Mais V, Ajossa S, et al. Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Human Reproduction. 1995;10:3133-3135

Adapted from Steege and Stout, Am J Obstet Gynecol, 1991. 

 Historically, the relationship between pelvic pain and adhesions has been a controversial area. Recent studies using laparoscopic techniques have clarified this relationship.
Although it is difficult to quantify the degree of pelvic pain, the McGill Evaluation score and the Multidimensional Pain Inventory are standard clinical techniques used to correlate the degree of pain with other clinical findings. Stout et al (1) used these two tests to show that patients with pelvic pain had a significantly greater amount of pain if adhesions were present, compared with the amount of pelvic pain in patients without adhesions. 

Reference:
1. Steege JF, Stout AL. Resolution of chronic pelvic pain after laparoscopic lysis. Am J Obstet Gynecol. 1991;164:73-79.