As we will soon see, most studies show a reduction in fertility after RP-IPAA. One hypothesis to explain this phenomenon is the presence of postoperative adhesions. Oresland  observed that, even if 20/21
women who underwent RP-IPAA had a normal physical examination, a hysterosalpingography showed some anomalies in 67% of subjects (14/21). Finding such as tubes adhered to the pelvis (48%) or bilateral tubal occlusion (10%) may certainly explain the decreased fertility, as recently emphasised by Diamond . An important bias in this work, however, is the lack of performance of an examination before surgery, making the comparison between the pre-and postoperative situation impossible. Also, a study by Sjogren  showed an altered endopelvic status with reduced uterine mobility in 47% of women after RP-IPAA or the presence of adnexal tenderness in 13%.
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