Adhesiolysis (Pelvic Adhesion Surgery)

Pelvic adhesions are bands of scar tissue that can form after inflammation, surgery, infection, or endometriosis. These bands can tether organs like the uterus, ovaries, bowel, and bladder to each other, which may result in pain, bowel or bladder symptoms, and even fertility issues.

Adhesiolysis is a surgical procedure to carefully release these adhesions. It is often performed at the same time as other laparoscopic procedures such as excision of endometriosis, ovarian cystectomy, or hysterectomy.

What are adhesions?

Adhesions are fibrous bands that develop as part of the body’s healing process. After surgery or inflammation, the body tries to repair itself, but in the pelvis this can lead to adjacent organs becoming abnormally attached to one another.

Adhesions can form after:

Endometriosis (especially deep or long-standing disease)
Pelvic inflammatory disease
Previous surgeries (e.g., caesarean section, appendectomy)
Ovarian torsion or ruptured cysts

Adhesions are not always painful, but they can:

Cause chronic pelvic or abdominal pain
Lead to painful periods or pain with sex
Impair bowel function or cause bloating
Reduce fertility by distorting normal anatomy

Surgical adhesions are bands of scar tissue that form inside the body, causing internal organs or tissues that are normally separate and slippery to stick (adhere) to one another. They are the body's natural healing response to the trauma of surgery, but they can also form after infection or inflammation.

When is adhesiolysis recommended?

Surgical removal of adhesions may be recommended if:

You have pain suspected to be due to adhesions
Imaging suggests severe distortion of pelvic anatomy
You are having another procedure such as endometriosis excision, and adhesions are found at the same time
Fertility is impacted due to tubal or ovarian adhesions

Adhesiolysis is an important part of managing pain and restoring pelvic anatomy in people with severe endometriosis or prior pelvic surgery. It’s rarely done in isolation, but when combined with targeted, expert surgery, it can significantly improve comfort and function.

It’s important to understand that adhesions can reform after surgery — especially if underlying inflammation (like endometriosis) is not controlled.

How is the surgery performed?

Adhesiolysis is done laparoscopically (keyhole surgery), often during surgery for another indication. Using small instruments and a camera, I carefully dissect the adhesions to restore normal anatomy and mobility.

Special techniques to reduce reformation of adhesions may include:

Minimising tissue trauma and using advanced energy devices
Irrigation to keep tissues moist
Applying anti-adhesion barriers or gels

What to expect after surgery

Mild to moderate pain for a few days, improving steadily
You may feel bloated or constipated initially
Depending on the extent of surgery, recovery is typically 1–2 weeks

If adhesiolysis is combined with other procedures (e.g., excision of endometriosis or ovarian surgery), recovery may take slightly longer.

Read more in my Surgical Recovery Toolkit.

Will the adhesions come back?

Unfortunately, adhesions may recur — especially in those with underlying inflammatory conditions like endometriosis.

Strategies to minimise recurrence include:

Careful surgical technique
Managing any active endometriosis postoperatively (e.g., hormonal therapy)
Avoiding unnecessary further surgery

I take a conservative and strategic approach to adhesiolysis, reserving it for cases where it is likely to make a real difference to your symptoms and health.

Dr Sam Holford

Is surgery for you?

If you have further questions, you’ll have the opportunity to discuss everything during your consultation — including whether surgery is right for you and what your alternatives are. All decisions are made together.

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FAQs

Can adhesions be seen on an ultrasound or MRI?

Adhesions themselves are often thin bands of scar tissue and are not usually visible on standard ultrasound or MRI scans. However, a specialist ultrasound may detect signs of adhesions, such as organs being stuck together or reduced mobility. A definitive diagnosis is typically made during surgery.

Will removing the adhesions guarantee my pain will go away?

While adhesiolysis can provide significant pain relief for many people, especially when adhesions are clearly restricting organs, there is no guarantee. Pelvic pain can be complex with multiple contributing factors. The goal is to restore normal anatomy and improve function, which often helps with pain.

What is the recovery like after adhesiolysis?

If performed as a standalone keyhole procedure, recovery is usually quick, with a return to normal activities in 1-2 weeks. If it's part of a larger surgery (like for severe endometriosis), your recovery will be guided by the more extensive procedure, typically taking 4-6 weeks.

What can be done to prevent adhesions from coming back after surgery?

Meticulous surgical technique is the most important factor. Using minimally invasive (laparoscopic) surgery, minimising tissue handling, and in some cases, using special anti-adhesion gels or barriers can help reduce the risk of recurrence. Controlling underlying conditions like endometriosis is also key.

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Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.