My surgery involved robotic segmental resection of the right tube with end-to-end anastomosis; right ovarian cystectomy; appendectomy; extensive ileal, sigmoidal, bilateral tubo-ovarian and uterine adhesiolysis (removal of adhesions); uterine suspension.
DESCRIPTION OF PROCEDURE: Under suitable anesthesia and in the semilithotomy position the patient was prepped and draped as customary. The abdomen appeared normal with no visible anomalies in the surface of the liver, gallbladder, stomach.
The ileum was adhesed to the pelvis as well as the sigmoid. Both tubes and ovaries were involved in dense thick adnexal masses fixed to the pelvic sidewall, back of the uterus, and cul-de-sac. An extensive adhesiolysis was carried out to return the anatomy back to normal, identifying a right ovarian cyst with subovarian adhesions, which was excised from the right ovary.
There was a large hemorrhagic necrotic mass that appeared to be originating from a ruptured midsegment of the right tube that was completely excised including the midsegment of the right tube. This mass was also involving the surface of the rectosigmoid, cul-de-sac, posterior uterine wall, and contralateral tube and ovary. An extensive bilateral tubo-ovarian adhesiolysis was performed, releasing the ovaries from the tubes and the ovaries from the parapelvic peritoneum. The cul-de-sac was also reconstructed, excising thick dense scar tissue from the anterior rectal wall and rectovaginal septum.
The bladder peritoneum was also thickened with scar tissue, and it was also excised. The uterus was in a markedly retroverted position and a uterine suspension was performed. The appendix was involved in the right conglomerate of the adnexal mass, and the base of the appendix was first divided with two Endoloops, transected, and then the tip of the appendix followed up to the area where the right tube appeared to have been ruptured. The appendix was then separated from the tube and exteriorized.
There was no gross evidence of endometriosis, although the thick dense scar tissue could have been secondary to old endometriosis or to the ruptured ectopic. A tuba1 dye study revealed no passage of the dye through the left tube, the fimbrial end of which could be identified. On the right side, the right tube was then anastomosed with four submucosal sutures of 5-0 Prolene. The pelvis was thoroughly irrigated with water.
Hemostasis was meticulously controlled with cautery. A methylene blue enema was then carried out and the integrity of the rectum confirmed. Once the hemostasis was excellent, a slurry of Seprafilm was spread throughout the entire pelvic area. Instruments were removed and incisions closed as customary. The patient tolerated the procedure well and was taken to the recovery room in good condition.
Although many women develop adhesions after surgery and never know it, in some women adhesions can cause serious complications, including:
Pelvic pain: One study found that 82 percent of 224 patients suffering from chronic abdominal pain had adhesions and no other disease. Other studies find that adhesions are the most common reason for chronic pelvic pain in women. This pain occurs because adhesions bind together normally separate organs and tissues. As you move throughout the day, these tissues stretch, affecting nearby nerves and causing pain.
Pain during intercourse: Adhesions can also cause pain during intercourse (a condition called dyspareunia).
Infertility: Adhesions that form as a result of certain types of gynecologic surgery, especially tubal surgeries and surgeries to remove fibroids (myomectomies), are a common cause of infertility. Adhesions between the ovaries, fallopian tubes or pelvic walls can prevent an egg from the ovaries from getting into and through the fallopian tubes. Adhesions around the fallopian tubes may make it difficult or impossible for sperm to reach the egg. One study found adhesions in 37 percent of 733 infertile women; in 41 of these women, adhesions were the only reason for their infertility. Overall, some experts suspect that pelvic adhesions may be responsible for up to 40 percent of infertility.
Bowel obstruction: Adhesions are one of the leading causes of intestinal blockages, responsible for 30 to 60 percent of all cases. Such obstruction limits or stops passage of feces through the intestines, leading to pain, nausea and vomiting, possibly resulting in infection and additional surgery.
Adhesions can also make other abdominal surgeries longer and more challenging. For instance, they may make it impossible to perform a laparoscopic procedure, meaning you must undergo an open abdominal incision, which typically has a greater risk of complications and pain and requires a longer recovery time.
I have good days and bad days. Ironically, I usually feel bad at the end of a good day. You see, when I think back on my day, I realize it would have been horrible without the assistance of medicine. A dozen thoughts pop into my mind: “How long can I do this?”… “Do people see me differently because of the stigmas attached to pain medications?”… “Can I live a normal life on pain medicine?”… “Would it be right to somehow start a family like this?”… “If not, how is that fair for my husband?” Then, I try to rationalize in my head, “It’s only temporary until they find a cure”… “Lots of people live normal lives yet have to take medication everyday for the rest of their lives.” I always find myself running this pattern through my head on good days. On bad days, I can’t see past the pain to worry about the future.
I wish I could just accept my situation and make the decision to live life to its fullest. I want to be able to move forward with a positive attitude. But in order to live each day without feeling like a hollow shell, I need to know what I am dealing with. I need a name for my illness and to know what caused it. How can I live with this if I don’t know what this is?