chapter  17
26 Pages

Pelvic Adhesive Disease

Since the advent of abdominal and pelvic surgery, adhesion formation has plagued the surgeon. In one of the earliest reports, Bryant, in 1872, described a case of fatal intestinal obstruction secondary to intra-abdominal and pelvic adhesions after removal of an ovarian tumor.1 This case introduced into clinical practice the concept of adhesions as a cause of postoperative morbidity and mortality. With this awareness, clinical interest in the process of adhesion formation and prevention began. Early investigations into adhesion prevention were characterized by the kind of trial-and-error that persists even in contemporary practice and clinical investigation. Several trials were undertaken without full knowledge of the pathogenesis or pathology of adhesion formation. Through the late 1800s to the early 1920s, a papain extract was used without success.2 Both bovine and human amnion were used through the 1930s for prevention of adhesions after extensive abdominal and pelvic surgery,3-5 a variation on the use of amnion popularized in the plastic surgical repair and reconstruction of traumatic injuries encountered by troops during World War I. Amniotic fluid was then tried. Eli Lily became sufficiently interested that Eli Lily Research Laboratories produced a concentrate of amniotic fluid called Amphitene.6 Both amnion and amniotic fluid remained in vogue through the 1940s.