Endometriosis, macrophages, and adhesions

In the judgement of most experienced clinicians, women with endometriosis are particularly prone to postoperative adhesion formation. Coincidently, a localized sterile PF inflammatory process is present in these women, although not exclusively confined to those with visible endometrial implants. This PF exudate contains numerous growth factors and cytokines, most secreted by the large population of activated macrophages, which have the potential to alter the tissue repair response. To further evaluate this possibility, attention will need to be focused on the nature of the PF immune system, changes in the PF immune response in various gynecologic disease states and the impact of surgery.