What are the symptoms of C-section adhesions. How can you identify scar tissue pain after surgery. What causes C-section adhesions and how are they treated. Learn about endometriosis risks following cesarean delivery.

Understanding C-Section Adhesions: A Comprehensive Overview

C-section adhesions are a potential complication following cesarean delivery that can cause significant discomfort and health issues for some women. These adhesions form when scar tissue develops abnormally, potentially leading to pain and other symptoms. While relatively uncommon, understanding the risks, symptoms, and treatment options for C-section adhesions is crucial for women who have undergone or are considering this surgical procedure.

Recognizing the Symptoms of C-Section Adhesions

Identifying C-section adhesions can be challenging, as symptoms may overlap with other postpartum conditions. However, some common signs include:

• Persistent abdominal pain, especially around the incision site
• Pelvic discomfort or a pulling sensation
• Difficulty with certain movements or positions
• Bowel or bladder issues
• Pain during sexual intercourse

Are these symptoms always indicative of C-section adhesions? Not necessarily. It’s essential to consult with a healthcare provider for a proper diagnosis, as these symptoms can also be associated with other conditions.

The Connection Between C-Sections and Endometriosis

While rare, endometriosis can develop after a C-section, a condition known as incisional endometriosis. This occurs when endometrial tissue implants in the surgical scar, leading to various complications.

Incidence and Risk Factors

The incidence of incisional endometriosis is relatively low, ranging from 0.03% to 0.45% of C-section cases. However, some researchers suggest that the actual number may be higher due to underreporting or misdiagnosis. As the number of C-sections performed globally continues to rise, healthcare providers are encountering more cases of C-section scar-related endometriosis.

Symptoms of Post-C-Section Endometriosis

Women experiencing endometriosis after a C-section may notice:

• Cyclic pain and swelling at the incision site
• Brown-like discharge from the scar during menstruation
• Severe menstrual cramps
• Pain between periods
• Discomfort during sexual intercourse
• Painful bowel movements
• Irregular bleeding
• Fertility issues

Can endometriosis symptoms improve during pregnancy? Some women with pre-existing endometriosis may experience temporary relief during pregnancy due to increased progesterone levels. However, this is not universal, and some individuals may continue to experience symptoms or develop new ones post-delivery.

Diagnosing C-Section Adhesions and Endometriosis

Accurate diagnosis of C-section adhesions and related complications like endometriosis is crucial for effective treatment. The diagnostic process typically involves:

1. Comprehensive medical history review
2. Thorough physical examination
3. Imaging studies (e.g., pelvic ultrasound)
4. Possible biopsy or exploratory surgery

Why is diagnosing these conditions often challenging? The symptoms can mimic other gynecological issues, and in some cases, adhesions may not be detectable through non-invasive methods. This complexity can lead to delayed diagnosis, with some studies indicating an average delay of 4.4 to 9 years between symptom onset and confirmed diagnosis.

Treatment Options for C-Section Adhesions and Scar Tissue Pain

Managing C-section adhesions and associated complications involves a range of treatment approaches, depending on the severity and specific symptoms:

Conservative Management

• Pain medications
• Physical therapy
• Massage techniques
• Heat therapy

Minimally Invasive Procedures

• Adhesiolysis (surgical removal of adhesions)
• Laparoscopic surgery

Advanced Surgical Interventions

• Excision of endometrial tissue
• Hysterectomy (in severe cases)

How effective are these treatments? Success rates vary depending on the individual case and chosen treatment method. Many women find significant relief through a combination of approaches tailored to their specific needs.

Preventing C-Section Adhesions: Strategies and Considerations

While not all C-section adhesions can be prevented, certain measures may help reduce the risk:

• Proper surgical technique and closure methods
• Use of adhesion barriers during surgery
• Early mobilization post-surgery
• Adequate nutrition and hydration
• Following postoperative care instructions carefully

Can lifestyle changes impact adhesion formation? While research is ongoing, maintaining a healthy lifestyle, including proper nutrition and regular exercise, may support overall healing and potentially reduce the risk of complications.

Long-Term Implications of C-Section Adhesions

Understanding the potential long-term effects of C-section adhesions is crucial for women’s health:

Fertility Concerns

Adhesions can potentially impact fertility by causing:

• Tubal blockage
• Altered pelvic anatomy
• Chronic pelvic pain affecting sexual function

Quality of Life Impact

Persistent adhesions may lead to:

• Chronic pain
• Limited mobility
• Psychological distress
• Reduced overall well-being

How can women manage these long-term effects? A multidisciplinary approach involving gynecologists, pain specialists, physical therapists, and mental health professionals can help address the various aspects of living with C-section adhesions.

Navigating Healthcare: Advocating for Proper Diagnosis and Treatment

Given the challenges in diagnosing and treating C-section adhesions and related complications, it’s essential for women to be proactive in their healthcare:

• Keep detailed records of symptoms and their timing
• Seek second opinions when necessary
• Research reputable sources of information
• Connect with support groups or patient advocacy organizations
• Communicate openly and honestly with healthcare providers

Why is patient advocacy crucial in managing C-section adhesions? The complexity and potential rarity of these conditions mean that not all healthcare providers may be equally experienced in recognizing and treating them. Being an informed and assertive patient can lead to more timely and effective care.

Emerging Research and Future Directions in C-Section Adhesion Management

The field of C-section adhesion prevention and treatment is evolving, with ongoing research focusing on:

• Advanced surgical techniques to minimize adhesion formation
• Novel adhesion barrier materials
• Pharmacological interventions to prevent or reduce adhesions
• Improved diagnostic tools for early detection
• Regenerative medicine approaches to tissue healing

What potential breakthroughs are on the horizon? While it’s difficult to predict specific outcomes, researchers are exploring various avenues to improve both the prevention and management of C-section adhesions, potentially offering hope for more effective treatments in the future.

Holistic Approaches to Managing C-Section Adhesion Symptoms

In addition to medical interventions, many women find relief through complementary approaches:

Mind-Body Techniques

• Meditation and mindfulness practices
• Yoga and gentle stretching
• Biofeedback therapy

Nutritional Strategies

• Anti-inflammatory diets
• Adequate hydration
• Specific supplements (under medical supervision)

Alternative Therapies

• Acupuncture
• Massage therapy
• Herbal remedies (with caution and medical advice)

How effective are these holistic approaches? While scientific evidence varies, many women report improved quality of life and symptom management when incorporating these methods into their overall treatment plan. It’s crucial to discuss any complementary approaches with a healthcare provider to ensure safety and compatibility with other treatments.

The Psychological Impact of C-Section Adhesions

Living with C-section adhesions and their symptoms can take a toll on mental health and emotional well-being. Common psychological challenges include:

• Anxiety about future pregnancies or surgeries
• Depression related to chronic pain or fertility concerns
• Body image issues due to scarring or persistent discomfort
• Relationship strain, particularly if sexual function is affected
• Frustration with the healthcare system if diagnosis is delayed

How can women address these psychological impacts? Seeking support through therapy, support groups, or counseling can be beneficial. Many women find that sharing their experiences with others who understand can provide comfort and valuable coping strategies.

Navigating Pregnancy and Delivery After C-Section Adhesions

For women who have experienced C-section adhesions and are considering future pregnancies, several factors come into play:

Pre-Conception Considerations

• Discussing fertility implications with a specialist
• Addressing any ongoing pain or symptoms
• Evaluating the need for adhesion removal before pregnancy

Pregnancy Management

• Close monitoring for potential complications
• Addressing any pain or discomfort related to adhesions
• Preparing for potential challenges during delivery

Delivery Options

• Evaluating the possibility of vaginal birth after cesarean (VBAC)
• Discussing the risks and benefits of repeat C-section
• Planning for potential adhesion-related complications during surgery

What are the chances of successful pregnancy after dealing with C-section adhesions? Many women go on to have healthy pregnancies and deliveries, but individual circumstances vary. Close collaboration with healthcare providers is essential to navigate this journey safely.

The Role of Technology in Managing C-Section Adhesions

Advancements in medical technology are playing an increasingly important role in the diagnosis, treatment, and management of C-section adhesions:

Diagnostic Innovations

• High-resolution imaging techniques for better visualization of adhesions
• Artificial intelligence-assisted image analysis for improved detection
• Minimally invasive diagnostic procedures

Treatment Technologies

• Robot-assisted surgical techniques for precise adhesion removal
• Advanced energy devices for tissue sealing and dissection
• Innovative adhesion barrier materials

Management Tools

• Mobile apps for symptom tracking and management
• Telemedicine platforms for remote consultations
• Wearable devices for pain monitoring and management

How are these technological advancements changing the landscape of C-section adhesion care? While many of these technologies are still evolving, they offer promise for more accurate diagnosis, less invasive treatments, and improved long-term management of adhesion-related issues.

Building a Support Network: Resources for Women with C-Section Adhesions

Coping with C-section adhesions can be challenging, but numerous resources are available to provide support and information:

Online Communities

• Forums and discussion boards dedicated to C-section complications
• Social media groups for peer support
• Virtual support groups facilitated by healthcare professionals

Educational Resources

• Reputable medical websites with information on adhesions and related conditions
• Webinars and online workshops on managing post-surgical complications
• Patient education materials from hospitals and clinics

Professional Support

• Referrals to specialists in adhesion management
• Access to multidisciplinary care teams
• Counseling services for emotional support

Why is building a support network crucial for women dealing with C-section adhesions? The journey can be emotionally and physically taxing, and having access to both informational and emotional support can significantly improve coping abilities and overall quality of life.

Endometriosis after C-section: Symptoms, treatment, and scars

Endometriosis following a C-section, or cesarean delivery, remains relatively rare, but it is a potential complication. It can cause scar tissue to develop, which may cause pain.

Endometrial tissue typically lines the uterus. Classic endometriosis occurs when endometrial-like tissue develops outside of the uterus.

This can cause the development of adhesions, or scar tissues. These can grow into large masses, or into bands that form between organs.

When endometriosis causes either inflammation or scar tissue, a person can experience heavy or painful periods, as well as pain between periods.

During pregnancy, a person already living with endometriosis may find that their endometriosis symptoms temporarily get better. This may result from increased levels of progesterone in the body during pregnancy.

However, this may not be true for every person. In some cases, the pain relief may be more related to the absence of a menstrual cycle during pregnancy. Some people may not experience any pain relief during pregnancy.

There is also evidence that endometriosis could develop after a c-section in people who did not have the condition prior to giving birth.

This article discusses endometriosis after a C-section, including how doctors diagnose and treat the condition.

Endometriosis can develop after a C-section when it develops inside the surgery scar, which is known as incisional endometriosis.

Incisional endometriosis is rare. The incidence of the condition is only 0.03-0.45%. However, the authors of a 2017 case report suggest that doctors are encountering more C-section scar-related endometriosis because the number of C-sections is rising.

The number could also be higher because not all people may realize they have endometriosis after having a c-section and may not report it.

When a surgeon performs a c-section, endometrial tissue is cut and can move outside the uterus. Endometrial tissue can implant in the area of the surgical scar.

The endometrial tissue then builds up along the scar, leading to painful adhesions that can affect a person’s fertility or make periods more painful. In addition, a person can experience inflammation, pain, and bleeding from the endometriosis lesions.

Surgery can effectively treat many cases of incisional endometriosis, as it involves removing the inflammatory endometrial tissue.

Incisional endometriosis can cause cyclic pain, swelling, and brown-like leakage at the site of the scar during menstruation. In addition, a person can experience the standard symptoms of endometriosis.

They include:

• severe pain during menstruation
• pain or cramps between periods
• pain during sex
• painful bowel movements
• bleeding between periods
• heavy or clot-filled periods
• trouble getting pregnant
• unexplained stomach pain, diarrhea, or constipation
• bladder pain that resembles a bladder or urinary tract infection

A person experiencing any of these symptoms should see their doctor to rule out endometriosis or another condition that may be causing similar symptoms.

Many people with endometriosis wait years for a diagnosis.

A 2017 study found that the average time between the beginning of symptoms and diagnosis in the United States was 4.4 years. Younger women tended to wait longer than older women for a diagnosis.

However, according to the Endometriosis Foundation of America, there can be as much as a 9-year delay in the diagnosis of endometriosis after the onset of symptoms. In cases of incisional endometriosis, doctors may take longer to diagnose the condition as it is rare and still not widely understood.

Generally, to ensure a prompt and accurate diagnosis, people who suspect they have endometriosis may need to see their gynecologist, specifically ask about endometriosis testing, or seek a second opinion.

Usually, doctors take a complete medical history and perform a pelvic exam before testing. A person may then need to undergo several tests to get an accurate diagnosis.

A doctor may be able to feel adhesions or endometrial growths during an exam, though this is uncommon. If a person experiences unusual pain during a pelvic exam, this may also be a sign of endometriosis.

If a pelvic exam causes a doctor to suspect endometriosis, other tests can confirm the diagnosis. These include:

• Pelvic ultrasound: During this procedure, a doctor uses sound waves to view the uterus and surrounding organs. They may insert a small transducer into the vagina to get a better look or use the transducer only on the outside of the abdomen.
• Biopsy: A doctor may use a needle to remove a small section of endometrial tissue. Testing this sample can help rule out other issues, such as cancerous growths.
• Exploratory surgery: Surgery like laparoscopy is the only way a doctor can definitely diagnose endometriosis in the abdominal wall. However, it is possible to diagnose incisional endometriosis with ultrasound, MRI, and typically by making a new incision at the old incision site and removing the tissue. A pathologist then examines the tissue to confirm the condition.

Endometriosis is a chronic illness with no cure. In cases of endometriosis after a c-section, surgery to remove the endometriosis is the most likely treatment. This is also more likely if a person wants to conceive again.

For endometriosis in general, surgery is not always the first treatment choice. There are other treatments that can manage symptoms that could benefit some people depending on their specific symptoms. Some treatments may also prevent endometriosis from getting worse. A doctor may recommend:

• over-the-counter or prescription pain medication.
• alternative pain management techniques such as acupuncture or massage therapy
• Hormonal birth control pills contain progesterone, which is a hormone that can help prevent endometrial tissue from growing. Learn more about birth control for endometriosis.
• Hormonal contraceptives that do not contain progesterone such as gonadotropin-releasing hormone (GnRH) agonists or antagonists.

In severe cases, people who do not want to become pregnant may choose a hysterectomy, which is surgery to remove the uterus. This may also include a bilateral salpingo-oophorectomy (BSO), in which the surgeon also removes the ovaries.

Learn about the new guidelines for endometriosis diagnosis and treatment.

Endometriosis is a chronic condition, but surgical and medical treatment can help manage the symptoms.

People who have used medication, such as progesterone, to control endometriosis often experience symptoms after stopping the treatment.

Even among people who have undergone surgery, endometriosis may come back. Treatment with progesterone or with GnRH agonists and antagonists may reduce the risk of recurrence or slow new growth.

A hysterectomy on its own can greatly reduce the risk of recurrence. Research from 2020 found that the proportion of women living with endometriosis who experienced pain went down by 28% after a hysterectomy

However, earlier research found that 62% of participants experienced endometriosis symptoms even after undergoing hysterectomies but keeping their ovaries. This means that in some cases, a person may need to have their ovaries removed as well.

The removal of ovaries, however, also comes with its own health risks. A person should make a decision on whether they need surgery and what kind of surgery is best in consultation with their doctor.

Is scar endometriosis dangerous?

Incisional endometriosis can cause pain and discomfort. But the condition is so rare, that there is not enough data to indicate whether it is dangerous. In extremely rare cases, the condition could become malignant, which means cancerous.

Why does my c-section scar hurt years later?

A person should not experience pain in the area of their scar years after a C-section. If they are experiencing pain, they may wish to rule out endometriosis or other conditions such as a hernia.

Learn more about hernias after a C-section.

Can a hard lump in the stomach after a C-section indicate endometriosis?

According to research, a lump in the c-section scar area could indicate endometriosis. It is likely to be chronically painful, but the pain may come and go in cycles.

What is post-partum endometritis?

Post-partum endometritis is a different condition than endometriosis, although both occur after pregnancy and delivery. When a person is pregnant, bacteria can reach the lining of the uterus and cause an infection. This can occur during vaginal delivery, but also during pregnancy through pelvic examinations, for example. The condition typically develops after delivery, which can be vaginal or via c-section. It affects up to 27% of caesarian births.

ADHESIONS AND SCARS THAT BIND: Do Cesarean / C-Sections cause adhesions and scarring?

The simple answer is Yes. Fibrous tissue or scarring, as well as adhesions, are part of the normal process of tissue healing. Skin takes about 5-10 days, top layers less than two months and the deeper layers and womb about 3 months to completely heal. Each additional Cesarean or C-Section
performed causes further accumulation of scarring and adhesions in the abdomen and incision site.

The photo here is an example of a cesarean scar and appendectomy scar. Looking at the picture, I notice three different lines of tension. First we look at the C-section, adhesions are pulling the scar deep and left into the pelvis. Then looking at the appendectomy scar which has keloid tissue (excess scar growth), this scar is being pulled upward toward the right ribs. Then the umbilicus or belly button is pulled up diagonally toward the right ribs.

How a scar or adhesion presents reveals a lot

How a scar presents its self can tell an expert in manual therapy, where adhesions superficially and deep within might be found. These lines of tension will also change and compromise the way our body functions and moves. Our bodies are amazing as to how much we are able to accommodate and compensate for injuries, scarring, and stress in general. But eventually, we can come to a breaking point or a point of no return.

Complications following Cesarean and C-Sections

• Pain in the abdomen, back or pelvis.
• Feeling like you can not stand up straight, trouble with twisting and bending, lifting up your legs
  above the hips without effort or reach overhead because of the scar pulling.
• New abdominal concerns of pressure, gas, bloating, cramps, constipation, menstrual pain, IBS.
• Abdominal weakness.
• Changes in bowels or bladder elimination, pain, urinary urgency or frequency.
• Unexplained lower extremity swelling.
• Pain sensitivity around the cesarean scar.
• Difficulty sitting or standing still, needing to frequently reposition to feel comfortable.
• Painful sexual relations.

An EXPERT in manual therapy will look at the whole body, not only the obvious external scarring
and adhesions, but will treat all associated soft tissues, muscles, ligaments, organs and vessels such as
the vein, arteries, nerves and lymphatics. The aforementioned tissues ultimately attached to our
bony skeleton, thus the skeletal system is part of the treatment. Goals of treatment are to resolve
not only the physical complaints but restore the function, elasticity and mobility of the scar and all
associated tissues. Adhesions be gone!

DID you know? I am a pioneer in Women’s Heath, I took my first seminar on the subject in 1997
and have specialized ever since. Adhesions and scarring is my EXPERTISE.

By filling out a patient history form at Marycoxphysicaltherapy.com you will receive a free consultation and advice from Mary Cox PT.

To the question of the prevention of adhesion formation during surgical interventions on the pelvic organs | Savelyeva I.V., Polyanskaya I.B., Krasnikova E.G., Kartavtseva T.A., Klishina A.S.

Prevention of adhesion formation during surgical interventions on the pelvic organs remains one of the important areas of modern operative obstetrics and gynecology. This is due, firstly, to a high incidence of tubal-peritoneal infertility in the structure of gynecological diseases [1, 5], and secondly, to a deterioration in the quality of life of patients due to the onset of pain and an increase in the risk of reoperations [3, 6] . Adhesion formation is a local response resulting from exposure to the peritoneum [4]. When the healing processes are balanced, the peritoneum is restored, and when the balance is disturbed, adhesions form. Factors that can cause imbalance are generally recognized as the imposition of chromium and catgut sutures, peritoneal tension, blood clots [7], i.e., almost all integral stages of surgical intervention in obstetrics and gynecology.
In the literature, in recent years, the use of various anti-adhesion barriers during surgical interventions has been widely discussed [2, 3, 5, 6]. Clinical cases of application of antiadhesion barrier (membrane) ColGARA in various situations in obstetrics and gynecology are described below.

Case No. 1
Operating surgeon: I.V. Savelyeva – head. Department of Obstetrics and Gynecology No. 1 of the Omsk State Medical Academy, MD, obstetrician-gynecologist of the highest category.
Health care facility: BUZOO “Clinical maternity hospital No. 6″, Omsk.
Operation. Pfanenstill ventricular surgery with excision of the skin scar. Cesarean section according to Derfler. Separation of adhesions in a blunt and sharp way.
Indications. Defective scar on the uterus after 2 caesarean sections. Adhesive disease of the pelvic organs.
Patient I., 34 years old, with a pronounced adhesive process in the small pelvis and an inferior scar on the uterus after 2 caesarean sections, was delivered promptly at the obstetrics clinic in Omsk. The inferiority of the scar was manifested by its thinning to 0.5 mm in the region of the left corner of the wound on the uterus for 3 cm. In connection with the further reproductive plans of the puerperal, a decision was made to use the KolGARA anti-adhesion barrier (Fig. 1).
The collagen membrane was fixed with sutures in the area of ​​the wound on the uterus after matching the edges before peritonization (Fig. 2).
After that, the adhesions were dissected in a blunt and sharp way between the sheets of the parietal and visceral peritoneum, the bladder, the greater omentum and in the region of the uterine appendages from 2 sides (Fig. 3).
In the postoperative period, ultrasound of the pelvic organs was performed on days 2, 5, and 8. and two-handed/bimanual examination after 1 month. after operation. There were no signs of inferiority of the scar on the uterus; on the contrary, it seems that a full-fledged scar is being formed, despite 3 caesarean sections.

Case #2
Operating surgeon: A.S. Klishina.
MPI: BUZOO “Clinical Oncological Dispensary”, gynecological department, Omsk.
Operation. Lower median laparotomy with excision of the old scar. Extirpation of the uterus with appendages. Omentectomy.
Diagnosis. Cystoma of the left ovary.
Patient A., 43 years old. Ultrasound revealed: to the right of the uterus, a volumetric formation emanating from the pelvic organs (cystoma? myomatous node?): 169x100x94 mm, similar in structure to the ovary, with parietal formation. SA 125 – 42.5 (norm up to 35). On examination P/v: the uterus is not enlarged, in the area of ​​the uterine fundus the formation is up to 10 cm in diameter (cystoma? myomatous node?), it is displaced along with the uterus, the uterus is relatively mobile, painless, the appendages on both sides are not defined, painless. Parameters: free. Discharges: light. Performed: hysteroscopy, separate diagnostic curettage. Histology: blood, mucus, small fragments of the mucous membrane of the cervical canal and the basal layer of the endometrium, scarce material. Culdocentesis – single superficial epitheliocytes. The council made a diagnosis: ovarian cyst, malignae, large uterine fibroids. Recommended: surgical treatment.
Intraoperatively: in the abdominal cavity – a pronounced adhesive process (the patient has a history of caesarean section) and a cystic-solid formation emerging from the right appendages, about 15 cm. The tumor is intimately soldered to the greater omentum, loops of the small and large intestines, mesentery. The uterus is located in the center, soldered to the bladder, increased to 7-8 weeks. pregnancy, with myomatous nodes (combined growth: intramural + submucosal), along the posterior surface of the uterus, a single subserous node of type 0.
KolGARA is placed on the area of ​​surgical intervention in order to prevent adhesions between intestinal loops, bladder and peritoneum (Fig. 4). Adhesiolysis, extirpation of the uterus with appendages, omentectomy were performed.
Due to the pronounced adhesive process in the abdominal cavity and pelvic organs and the need to establish an anti-adhesion barrier, it was decided to use the KolGARA membrane. During the operation, the membrane was not fixed. There were no difficulties in setting up the KolGARA barrier. Before use, the membrane and the surgeon’s hands were moistened with saline, only wet tupfers were used. If necessary, it is advisable to make additional incisions on the membrane for its best overlay.

Case No. 3
Operating surgeon: M.N. Damn.
MPI: OGAZ “Irkutsk city perinatal center”, department of gynecology No. 2.
Operation. Planned laparoscopy. Myomectomy. Adhesiolysis. Chromosalpingoscopy.
Patient V., 34 years old, was admitted for planned surgical treatment with a diagnosis of large subserous uterine myoma, infertility I.
For the first time, uterine fibroids were discovered 5 years ago (3. 0 cm). From the then proposed intake of combined oral contraceptives (in order to stop the growth of the node and prevent the appearance of new ones), she refused. She did not visit a gynecologist and did not have an ultrasound scan.
History: chlamydia (2013). Treated with control. In 2014, she applied for the absence of pregnancy for 2 years with regular sexual activity with one sexual partner (examined: normozoospermia).
Surveyed:
– somatically healthy;
– hormonal status – without features;
– ovulatory cycle;
– sexually transmitted infections – not detected;
– hysterosalpingography (HSG) – the fallopian tubes are passable. Peritubular adhesive process is not excluded;
– Ultrasound – the body of the uterus is of normal size. Myometrium is homogeneous. On the back wall (on a wide base) subserous myomatous node 8.9×7.2 cm. The structure of the node is homogeneous. There are no signs of malignancy. The ovaries are of normal size. The right ovary has a corpus luteum.
Taking into account infertility, pregnancy planning, a high probability of adhesions after chlamydia, HSG data (peritubular adhesions are not excluded), subserous localization of the myomatous node and the available conditions for myomectomy by endoscopic access (technical equipment, surgeon’s qualifications), it was decided to perform laparoscopy, adhesiolysis , myomectomy, suturing the node bed. In order to prevent adhesions in the postoperative period (a large wound surface on the uterus, existing peritubal adhesions), to restore and preserve reproductive function, use the KolGARA anti-adhesion barrier.
Application area: application of the KolGARA anti-adhesion barrier on the posterior wall of the uterus in the area of ​​the suture.
The progress of the operation is shown in Figures 5–12.
The introduction of the Kolgar membrane into the abdominal cavity was carried out through an 11 mm trocar. The manipulations lasted about 3 minutes and were not difficult.
The membrane spreads easily, but the manipulations must be quick and well calibrated.
Due to its own adhesive properties, ColGARA quickly and firmly fixed (adhered) to the serous cover of the uterus, without requiring additional fixation (suturing), which would be traumatic for the uterus.
The postoperative period was uneventful, without complications. Intestinal peristalsis recovered on the 1st day. after operation. There was no temperature reaction. Blood tests over time were normal. According to ultrasound, there were no signs of inflammation, swelling of the sutures, and no indirect signs of adhesions were found. The patient was discharged home on the 5th day.
Control ultrasound 02.02.15. The body of the uterus is of normal size. Myometrium is homogeneous. The ovaries are of normal size and structure.

Thus, the use of the ColGARA antiadhesion barrier is convenient, characterized by a high safety profile (during the observation period, no allergic and purulent-inflammatory complications were noted) and can be recommended for widespread use in obstetric and gynecological practice.
Practical experience shows that before application, the membrane can be moistened with saline, additional cuts can be made on it. These manipulations contribute to its best imposition.

Literature
1. Gasparov A. The state of the reproductive system of patients with pelvic peritoneal adhesions and infertility / A. Gasparov, E. Dubinskaya, S. Nazarov et al. // Vrach. 2010. No. 7. P. 43–45.
2. Dubrovina S.O. Prevention of peritoneal adhesions in operative gynecology / S.O. Dubrovina // Gynecology. 2012. V. 14. No. 6. S. 46–50.
3. Kira E.F. The use of anti-adhesion barriers in myomectomy in women of reproductive age / E.F. Kira, A.L. Levchuk, K.Yu. Vyazmina // Bulletin of the National Medical and Surgical Center. N.I. Pirogov. 2009. T. 4. No. 2. S. 50–52.
4. Kondratovich L.M. Fundamentals of understanding the formation of adhesions in the abdominal cavity. Intraoperative prophylaxis with anti-adhesion barrier drugs / L. M. Kondratovich // Bulletin of new medical technologies. 2014. V. 21. No. 3. S. 169–173.
5. Totchiev G.F. Adhesive disease: physiological aspects, prevention mechanisms / G.F. Totchiev // Effective pharmacotherapy. 2013. No. 28. P.18–20.
6. Fatkullin I.F. The results of complex treatment of tubal pregnancy using mini-invasive endoscopic technologies and a modern anti-adhesion barrier / I.F. Fatkullin, Sh.A. Aliev // Medical almanac. 2009. No. 4 (9). pp. 86–89.
7. Fletcher N.M., Jiang Z.L., Diamond M.P. Hypoxia-generated superoxide induces the development of the adhesion phenoptype // Free Radic. Biol. Med. 2008 Vol. 45. P. 530–536.

Intrauterine adhesions – Hadassah Medical Moscow

Methods for diagnosing synechia

Symptoms of adhesions in the pelvis can characterize many diseases. Therefore, detailed studies are needed. The presence of synechia can be identified by a gynecologist, since adhesions may be immobile or may have little activity during examination of the uterus and appendages. The patient may experience pain and discomfort during the examination. Diagnosis of synechia includes the following studies:

Microflora smear

PCR analysis

Ultrasound and/or MRI

Laparoscopy

Hysteroscopy

is the gold standard in the diagnosis of intrauterine synechia. The method allows you to visualize the internal cavity of the uterus, see the picture from the inside and evaluate the spread of the process. The main method of treatment is surgical, the purpose of which is to remove adhesions.

Depending on the degree of the disease, intrauterine adhesions are treated using two methods:

1. Hysteroscopy. It is indicated for mild and moderate forms of the disease. The method is characterized by the removal of adhesions, the restoration of full menstrual function and fertility.
2. Laparoscopy. It is used in a severe form of the pathological process. Prevents the development of perforation.

Treatment includes removal of adhesion by hysteroscopy. The operation does not require general anesthesia.

The disease has a high risk of recurrence. Therefore, repeated hysteroscopy is prescribed to monitor the effectiveness of treatment, early diagnosis of relapse and the spread of the disease.

In the postoperative period, antibiotic treatment is prescribed to prevent infectious complications. Drug therapy should be supplemented with hormonal drugs. The use of estrogens and progestins to stimulate the growth of the endometrium has been shown.

Prevention and treatment programs for intrauterine adhesions at the Hadassah Clinic

In a medical center in Moscow with synechia, surgery is performed for such indications as the presence of pain, stagnation of menstrual flow, uterine deformity, miscarriage and female infertility. The decision on the advisability and need for surgical intervention is made individually based on the available factors. The advantage of the Hadassah clinic lies in modern equipment, high competence of specialists and the use of low-impact treatment methods.