Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them.

OBJECTIVE

To review the clinical data that specifically address the contribution of pelvic adhesive disease to pelvic pain and the use of intraperitoneal crystalloid instillants in the prevention of postoperative pelvic adhesions.

STUDY DESIGN

A review of contemporary reports that describe relevant clinical studies.

RESULTS

The data on adhesions and pelvic pain suggest that adhesions can cause pelvic pain and that adhesiolysis relieves pain in 60-90% of cases. Adhesions in patients with pelvic pain are associated with restricted motion or expansibility of organs, whereas adhesions in patients without pain usually cause no such restriction. Even though hydroflotation may appear to be effective at very early postoperative intervals, the process of peritoneal repair, fibrin deposition and adhesion formation extends well beyond the time of crystalloid absorption.

CONCLUSION

Laparoscopy is appropriate in patients with pelvic pain. Adhesions found in those patients, especially involving the adnexa, should be removed. Clinical evidence does not support the use of crystalloids in adhesion prevention.