Adhesions are the scar tissue bands which develop between the organs. They are common in the abdomen area of about 95% patients after abdominal surgery which is normal healing process of the body. Most of the adhesions do not cause symptoms however some of the adhesions cause bowel obstruction, chronic pain and infertility. Adhesions can be removed by a surgery called laparotomy adhesiolysis for bowel obstructions. If other non operative measures fail some patients may also require surgery which also leads to formation of new adhesions in 40% of patients which may require another surgery to remove the adhesions. Adhesions form as the body attempts to repair from surgery, infections, radiation etc. During the repair process one organ may come in to contact with another resulting in the generation of scar tissue between the two surfaces. Adhesions may develop anywhere in the body but most common in abdomen, pelvis and heart which are often painless and may sometimes cause obstruction which may be life threatening.
- During laparoscopic surgical procedure
- Studies such as blood tests
- CT scans
- Barium contrast studies
The treatment for adhesions depends on the extent of adhesion, location and the problems caused by them. They can improve without surgery and the symptoms can be treated without surgery
The two common procedures such as laparoscopy and laparotomy can be used to treat the adhesions.
- Laparoscopy- Adhesion removal using laparoscopy called as adhesiolysis. The surgeon will make a hole in the body where the adhesions are formed and a small camera will be placed through the hole to detect the presence of adhesions. After detection they are cut and released.
- Laparotomy- The surgeon will make a large cut to check the adhesions directly and release them. In Laparotomy, the doctor makes a larger incision which helps to see the adhesions directly so that they can be treated them. The technique varies depending on specific circumstances.
Before the Procedure
Certain medications should be stopped before the surgery such as:
- Blood thinners and anti coagulants
- Non steroidal anti inflammatory drugs such as Aspirin and Ibuprofen
- Medicines which affect blood clotting
- Dietary supplements and Herbal medicines
- Vitamin K containing products
During the Procedure
- Laparoscopy surgery can be performed in a hospital or in a clinic as outpatient.
- General anaesthesia will be given through intra venous method
- If local anaesthesia is given, it will numb the area for certain period of time
- The surgeon will make an incision below the belly button and insert a canula to locate the adhesions
- The cannula will be used to inflate the abdomen with carbon dioxide gas which allows the surgeon to see the organs more clearly
- After the inflation the surgeon will insert a laparoscope through the incision to access the internal organ as it generates the images on the screen
- The number of incisions depends on the number of adhesions to be removed with the size ranging from 1 to 2 cm
- After the adhesiolysis, the laparoscope will be removed and the incisions are closed with stitches or surgical tape
After the Procedure
- After the procedure the patient may feel slight pain and throbbing in the area of incision
- The pain will resolve within few days after the procedure
- Pain relief medications will be advised for few days after the surgery
- The common side effect is discomfort and pain in the shoulder after the procedure due to the carbon dioxide used to inflate the abdomen
- Bloating may also be observed in some patients that subsides within couple of days
- Normal activities can be resumed in a week after the procedure
- Follow up appointments will be scheduled after two weeks post surgery