Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS)

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated July 27, 2026

Near Adhesion-Free Reconstructive Pelvic Surgery (NARPS) is a surgical approach developed to systematically minimize the formation of new adhesions during and after complex pelvic surgery.¹ The central premise is that while postoperative adhesion formation cannot be eliminated entirely, it can be reduced substantially through deliberate, technique-level choices at every stage of the operation.

NARPS applies principles of magnification, sharp rather than blunt dissection, continuous peritoneal irrigation, careful hemostasis, and placement of anti-adhesion barriers at closure. Each element targets a known mechanism of adhesion formation: desiccation, ischemia, bleeding, and peritoneal trauma. No single step accounts for the outcome. The reduction comes from applying all of them consistently.

The 2010 outcomes paper documented three distinct phases of refinement over 23 years: Phase I (1987 to 1993, 26 patients), Phase II (1994 to 2005, 44 patients), and Phase III (2006 to 2009, 25 patients).¹

Using the American Fertility Society (AFS) adhesion scoring system, total adnexal adhesion scores fell from 33.8 to 18.1 in Phase I, from 33.3 to 6.0 in Phase II, and from 33.2 to 2.5 in Phase III, across the full 95-patient cohort.¹ Each within-phase decline was significant at P<0.001, and the between-phase improvement measured at second-look laparoscopy was significant at P<0.01.

NARPS is closely associated with pelvic excision and repair surgery. Where that entry describes the procedure applied to specific pathology, NARPS describes the set of technical principles governing how that procedure is performed. The two concepts work together: one names what is done, the other names how it is done to protect the tissue afterward.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.