Clinical Determinants and Operative Impact of Adhesions in Women Undergoing Laparoscopic Gynaecological Surgery: A Retrospective Analysis

Background: Adhesions are abnormal fibrous bands that join two normally separate anatomical structures and remain one of the most frequent sequelae of gynecological surgery. They contribute to chronic pelvic pain, infertility, and bowel obstruction, making their recognition clinically important.Objectives: To determine the prevalence, severity, anatomical distribution, associated factors, and operative consequences of adhesions in women undergoing laparoscopic gynecological surgery at Teaching Hospital Peradeniya (THP).Methods: A retrospective analysis of operative notes and patient records was conducted for all women who underwent laparoscopic gynecological surgery at THP. Data collected included patient demographics, prior surgical history, presence and severity of adhesions, and intraoperative outcomes.Results: Of the 391 procedures reviewed, adhesions were present in 46.5% of patients. Pelvic adhesions were most common (54.4%), followed by abdominal (22.5%) and mixed abdominal-pelvic adhesions (20.3%). Thin/filmy adhesions accounted for 56%, while thick/fibrous bands comprised 43.4%. Severe adhesions were found in 42.62%. Previous abdominal or pelvic surgery (χ2=79.331, p < 0.001), endometriosis (χ2=15.424, p < 0.001), and subfertility (χ2=6.149, p = 0.013) were significantly associated with adhesion development. Intraoperative difficulties occurred in 30.6% of patients with adhesions, including increased bleeding, prolonged duration, and entry injuries. Conversion to open surgery occurred in 1.3% of cases, predominantly among those with moderate or severe adhesions.Conclusions: Adhesions are common among women undergoing laparoscopic gynecological surgery and are strongly associated with previous abdominopelvic surgery, endometriosis, and subfertility. Adhesion severity correlates with increased operative difficulty and conversion to open surgery. Understanding associated risk factors can help optimize surgical strategies to reduce adhesion-related morbidity.