Surgery For Adhesions
Adhesions Overview
An adhesion is a band of scar tissue that binds tissue together in the abdomen that should not be attached. Adhesions may appear as thin filmy tissue that seperate easily or as thick fibrous bands that are very tough and difficult to seperate. This scar tissue develops when the body’s repair mechanisms respond to tissue injury from surgery, infection, trauma, or radiation and the like. Repair cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself, or another organ, scar tissue may form to connect the 2 surfaces.Although adhesions can occur anywhere, the most common locations are within the abdomen and pelvis.
- Abdominal adhesions: Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in 10.4% of people who have never had surgery.
- Most adhesions are painless and do not cause complications. However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic abdominal pain.
- Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines a blockage an occur. In extreme the adhesions can cause a contriction of blood flow and lead to emergency surgery due to tissue death.
Adhesions Symptoms
Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed.
- Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.
- Adhesions above the liver may cause pain with deep breathing.
- Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
- Adhesions involving the vagina or uterus may cause pain during intercourse.
- It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
- Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency. These adhesions trigger waves of cramplike pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines. Once the pain starts, you may vomit. This often relieves the pain. Your stomach may become tender and progressively bloated. You may hear high-pitched tinkling bowel sounds over your stomach, accompanied by increased gas and loose stools.
Exams and Tests
There is no definite test for adhesions. This diagnosis is usually suspected when all other tests for the evaluation of chronic abdominal/pelvic pain is negative. Doctors typically diagnose adhesions during a surgical procedure such as laparoscopy (putting a camera through a small hole into the abdomen). In years past this was referred to as “exploratory surgery.”
Surgery
Two common surgical techniques used to treat abdominal adhesions are laparoscopy and laparotomy.
- With laparoscopy, a doctor places a camera into your body through a small hole in the skin to confirm that adhesions exist. The adhesions then are cut and released (adhesiolysis).
- In laparotomy, a doctor makes a larger incision to directly see adhesions and treat them. The technique varies depending on specific circumstances.
Adhesions requiring surgery commonly come back because surgery itself causes adhesions and there is no guarantee that pain from adhesions will resolve by cutting the adhesions.
