Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Part 9 of 9 in Benign Growth in Uterus Causing Gynaecological Problems
Preventing Adhesions After Myomectomy: What Actually Works
August 25, 2024
A doctor asked a direct, practical question after describing a specific case: following myomectomy, is physical therapy the only helpful option for reducing adhesions?
What actually reduces adhesion formation
Dr. Lal's answer was direct: adhesion formation is a normal risk of any surgery, with some patients forming more than others regardless of technique, and physical therapy, medication or dietary measures don't meaningfully reduce it. What genuinely helps is surgical technique itself: precisely opposing tissue during closure, avoiding leaving blood pooled inside the abdomen, thoroughly cleaning the surgical field, and placing a drain when there's more bleeding so it exits the body rather than organising into adhesions. An anti-adhesive barrier, such as omentum placed over the repair site or a purpose-made anti-adhesive material, can also help prevent tissue from sticking.
The role of infection control
One further factor Dr. Lal flagged: proper sterilisation of surgical instruments matters directly, since a post-surgical infection significantly increases the amount of adhesion formation a patient goes on to develop.
This article is based on a Jivo Masterclass session conducted by Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Suman Lal taught doctors across Africa on August 25, 2024.
FROM THE LIVE Q&A
Moderator
What is the relationship between fibroids and menstrual pain?
Dr. Suman Lal
A fibroid inside the uterine cavity acts like a foreign body. When menstrual contractions begin, the uterus tries to expel the fibroid the same way labour contractions try to expel a baby, causing cramping. An intramural fibroid also increases the uterus's surface area, independently increasing both pain and bleeding.
Frequently Asked Questions
What is the fate of myoma nuclei after embolization, and why is it contraindicated in women wishing to conceive in the future?▼
Embolization blocks the artery supplying the uterus, so blood flow to the entire uterus decreases, not just to the fibroid. That reduced blood flow is exactly why the procedure is contraindicated for women planning pregnancy afterward, since it can compromise the nutrition and growth of a future baby. For these patients, myomectomy (surgical removal) is the right choice instead.
In cases of infertility, is there any actual management in terms of medication?▼
Infertility has several possible causes, blocked tubes, inadequate egg count, or structural issues like fibroids, adenomyosis or endometriosis, and each needs a different treatment. For a woman with fibroids who wants to avoid surgery before conceiving, a GnRH agonist can shrink the fibroid over six to nine months, after which medication can be given to support pregnancy.
Can endometriosis be cured completely, and how can someone with endometriosis get pregnant easily?▼
Complete cure of endometriosis is mostly not possible, but early detection and adequate treatment are key. If an endometrioma is found, a thorough cystectomy removing all endometriotic tissue at the first surgery is the most important step; getting this first surgery right substantially reduces recurrence and preserves the chance of pregnancy.
What is the best way to treat PCOS?▼
PCOS is fundamentally a lifestyle disease, so lifestyle changes, decreased stress, better diet, exercise and meditation, are the most important treatment. Beyond that, treatment targets specific symptoms: hormonal pills for delayed periods, targeted medication for acne or hair loss, and ovulation induction with specialist support for women not conceiving.
After a myomectomy there is some adhesion trouble. Is physical therapy the only helpful therapy for reducing those adhesions?▼
No. Adhesion formation is a normal surgical risk that varies between patients regardless of physical therapy, medication or diet. What genuinely helps is surgical technique: precisely opposing tissue, avoiding pooled blood inside the abdomen, thorough cleaning of the surgical field, placing a drain when there's more bleeding, and using an anti-adhesive barrier such as omentum or a purpose-made material over the repair site. Proper instrument sterilisation also matters directly, since infection significantly increases adhesion formation.
Does physical therapy help prevent adhesions after myomectomy?▼
No. Physical therapy, medication and dietary measures don't meaningfully reduce adhesion formation; surgical technique (tissue apposition, avoiding pooled blood, drains, anti-adhesive barriers) is what actually helps.
Does infection increase adhesion formation after surgery?▼
Yes. A post-surgical infection significantly increases the amount of adhesion formation, which is why proper instrument sterilisation matters directly.
In This Series: Benign Growth in Uterus Causing Gynaecological Problems
- 1.Uterine Fibroids
- 2.What Are Uterine Fibroids? Risk Factors and Symptoms
- 3.Diagnosing and Classifying Fibroids by Location
- 4.Fibroids, Fertility, Pregnancy Risk and Menstrual Pain
- 5.Medical Management: Painkillers, Progesterone and GnRH Agonists
- 6.Uterine Artery Embolization: When It Works and When It's Contraindicated
- 7.Surgical Removal: Hysteroscopic, Laparoscopic and Robotic Myomectomy
- 8.Beyond Fibroids: PCOS, Endometriosis and Infertility
- 9.Preventing Adhesions After Myomectomy: What Actually Works