ADHESIVE DISEASE IN GYNECOLOGY: EPIDEMIOLOGY, PATHOGENESIS, CLINICAL IMPACT, AND CURRENT CHALLENGES IN PREVENTION AND MANAGEMENT

Abstract

Adhesive disease in gynecology represents one of the most persistent and clinically relevant challenges in abdominal and pelvic surgery. It is characterized by abnormal fibrous connections between peritoneal surfaces that develop after tissue injury and surgical intervention. Unlike simple postoperative scarring, adhesions constitute a dynamic biological process involving inflammation, fibrin deposition, fibroblast proliferation, and extracellular matrix remodeling, ultimately leading to permanent anatomical distortion of pelvic organs. The clinical importance of this condition extends beyond surgical morphology. Adhesions are strongly associated with tuboperitoneal infertility, chronic pelvic pain syndromes, bowel obstruction, and increased complexity of repeat surgical procedures. In reproductive-age women, even limited adnexal adhesions may significantly impair fertility by disrupting ovum capture, tubal motility, and tubo-ovarian alignment. Epidemiologically, postoperative adhesions remain extremely common despite the evolution of minimally invasive surgery. Large cohort analyses suggest that intra-abdominal adhesions develop in up to 60–90% of patients after major abdominal or pelvic surgery, with gynecological procedures being among the most affected. Importantly, adhesions are not static findings; they contribute to long-term morbidity, repeated hospitalizations, and reoperations over many years. Although laparoscopic surgery has significantly reduced tissue trauma compared to open surgery, it has not eliminated adhesion formation. Risk persists due to multiple interacting factors, including peritoneal ischemia, endometriosis-related inflammation, intraoperative bleeding, thermal injury from energy devices, and repeated surgical exposure.

Therefore, adhesive disease should be considered a multifactorial, chronic, and system-wide surgical problem rather than a simple postoperative complication.