About Pelvic Adhesions

Pelvic adhesions are abnormal bands of scar tissue that form after gynecological surgeries, like C-sections, and bind organs that are usually not connected.

Most patients develop adhesions after pelvic surgery.¹

What causes pelvic adhesions?

All of the abdominal and pelvic organs, except the ovaries, are at least partially wrapped in a clear membrane called the peritoneum (per-i-toe-nee-um). When the peritoneum is damaged during surgery, it becomes inflamed. Inflammation is normal and part of the healing process, but inflammation also encourages fibrous bands of scar tissue to develop.

Usually, this scar tissue dissolves, and the area continues to heal. In some cases, however, the scar tissue may develop into adhesions that grow and connect pelvic organs or tissues that normally are separate.

How common are pelvic adhesions?

Adhesions are very common after pelvic or abdominal surgery. The chances that adhesions will form after surgery and what problems may result depend on many things: the type of surgery you’re having, the number of previous surgeries you've had, and the surgical technique used.

Most patients develop adhesions after pelvic surgery. In fact, studies have shown that adhesions formed in 55-100% of patients who had reproductive pelvic surgery.¹

What problems are caused by pelvic adhesions?

Pelvic adhesions may result in the following symptoms or complications:

Chronic pelvic pain – adhesions are found in about 25% of women with chronic pelvic pain²
Increased potential for bladder injury during subsequent surgery³
Infertility – up to 20% of infertility in women may be caused by adhesions⁴
Bowel obstruction – postoperative adhesions are the most common cause of small bowel obstruction⁵

References:
1.	diZerega GS. Peritoneum, peritoneal healing, and adhesion formation. In: diZereg GS ed. Peritoneal Surgery. New York, NY: Springer; 2000; 16.
2.	Howard FM, Chronic pelvic pain. Obstet Gynecol. 2003;101:606.
3.	Van Goor H, Consequences and complications of peritoneal adhesions. The Association of Coloproctology of Great Britain and Ireland, 2007;9(2):25-34.
4.	Hershlag A, Diamond MP, DeCherney AH. Adhesiolysis. Clin Obstet Gynecol. 1991; 34:395.
5.	Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol. 1999;180(2):313-315.

Next: Reducing the Risk of Pelvic Adhesions

Risk Information

GYNECARE INTERCEED^®
ABSORBABLE ADHESION BARRIER PATIENT EPI

INDICATIONS: GYNECARE INTERCEED^® Absorbable Adhesion Barrier is indicated as an adjuvant in open (laparotomy) gynecologic pelvic surgery for reducing the incidence of postoperative pelvic adhesions after meticulous hemostasis is achieved consistent with microsurgical principles.

CONTRAINDICATIONS: The use of GYNECARE INTERCEED^® Absorbable Adhesion Barrier is contraindicated in the presence of frank infection. GYNECARE INTERCEED^® is not indicated as a hemostatic agent. Appropriate means of achieving hemostasis must be employed.

WARNINGS: The safety and effectiveness of GYNECARE INTERCEED^® in laparoscopic surgery or any procedures other than open (laparotomy) gynecologic microsurgical procedures have not been established.

Postoperative adhesions may be induced by GYNECARE INTERCEED^® application if adjacent tissues (eg, ovary and tube) and structures are coapted or conjoined by the device, or if GYNECARE INTERCEED^® is folded, wadded or layered. Postoperative adhesions may occur in the presence of GYNECARE INTERCEED^® if meticulous hemostasis is not achieved prior to application. As with all foreign substances, GYNECARE INTERCEED^® should not be placed in a contaminated surgical site.

PRECAUTIONS: Use only a single layer of GYNECARE INTERCEED^®, since multiple layers of packing or folding will not enhance the adhesion barrier characteristics and may interfere with the absorption rate of
GYNECARE INTERCEED^®. Care should be exercised in applying GYNECARE INTERCEED^® to a pelvic organ not to constrict or restrict it. If the product comes in contact with blood prior to completing the procedure, it should be discarded, as fibrin deposition cannot be removed by irrigation and may promote adhesions formation. Ectopic pregnancies have been associated with fertility surgery of the female reproductive tract. No data exist to establish the effect, if any, of GYNECARE INTERCEED^® on the occurrence of ectopic pregnancies. No adequate studies have been conducted in women who have become pregnant within the first month after exposure to GYNECARE INTERCEED^®. No teratogenic studies have been performed. Therefore, avoidance of conception should be considered during the first complete menstrual cycle after use of GYNECARE INTERCEED^®. The safety and effectiveness of using
GYNECARE INTERCEED^® in combination with other adhesion prevention treatments have not been clinically established. GYNECARE INTERCEED^® is supplied sterile. As the material is not compatible with autoclaving or ethylene oxide sterilization, GYNECARE INTERCEED^® must not be resterilized. Foreign body reactions may occur in some patients. Interactions may occur between GYNECARE INTERCEED^® and some drugs used at the surgical site. Pathologists examining sites of GYNECARE INTERCEED^® placement should be made aware of its usage and of the normal cellular response to GYNECARE INTERCEED® ‘to facilitate proper evaluation of specimens'.

ADVERSE REACTIONS: The type and frequency of adverse events reported are consistent with events typically seen following surgery. Postsurgical adhesions may occur in the presence of GYNECARE INTERCEED^®.

For more information, please consult your doctor or call 1-888-GYNECARE to speak with a nurse

GYNECARE INTERCEED® Absorbable Adhesion Barrier