Lysis of adhesions is a surgical procedure designed to treat internal scar tissue, known as adhesions, most commonly found in the abdominal or pelvic cavities. The term “lysis” translates to “breaking down” or “separating,” and the goal is to surgically divide or remove these fibrous bands of tissue. This intervention is performed when the scar tissue begins to cause health complications by pulling on or obstructing normal anatomical structures. The procedure, also known as adhesiolysis, aims to restore the natural movement and function of the internal organs.
Understanding Adhesions
Adhesions are the body’s internal form of scar tissue, composed of fibrous bands that connect organs or tissues that should naturally remain separate. They form as a natural part of the healing process following any disturbance to the internal tissues. The underlying cause is often inflammation and the activation of the body’s coagulation system, which deposits a protein called fibrin onto the damaged surfaces.
The most frequent trigger for adhesion formation is prior surgery, with up to 93% of patients who undergo abdominal surgery developing some degree of scar tissue. Other common causes include inflammatory conditions like endometriosis, infections such as pelvic inflammatory disease or appendicitis, or internal trauma. Adhesions are most commonly found within the abdominal cavity, connecting loops of the intestines to each other or to the abdominal wall, or in the pelvis, where they can affect the reproductive organs.
Symptoms That Require Intervention
Although many people have adhesions without experiencing any issues, the scar tissue can sometimes cause significant health problems that necessitate surgical intervention. These fibrous bands can tether organs, restricting their free movement and leading to chronic pain, which is one of the most common reasons for a lysis procedure. This long-term pain is often described as vague, crampy, or generalized across the abdomen or pelvis.
A more immediate and severe complication is the development of a small bowel obstruction, a medical emergency that occurs when adhesions constrict or kink the small intestine. This kinking prevents the normal passage of food, fluid, and gas through the digestive tract, leading to symptoms like severe cramping, bloating, nausea, and an inability to pass stool or gas. If the obstruction is complete, it can cut off the blood supply to the bowel tissue, requiring urgent surgery to prevent tissue death and potential life-threatening infection.
In the pelvis, adhesions can also contribute to female infertility by physically covering or distorting the fallopian tubes and ovaries. The presence of scar tissue can prevent the egg and sperm from meeting, interfering with the conception process. Lysis of adhesions in these cases is intended to free the reproductive organs, restoring their normal anatomical relationship and improving the chances of conception.
The Surgical Process of Lysis
The surgical procedure to separate and remove adhesions is called adhesiolysis, with the goal being to restore the organs to their normal, non-adherent positions. Surgeons utilize specialized instruments to carefully divide the fibrous bands, which can range from thin, sheet-like structures to thick, dense cords. The choice of surgical approach depends heavily on the extent and location of the adhesions, as well as whether the procedure is an emergency.
The preferred method is often laparoscopic surgery, a minimally invasive approach involving several small incisions in the abdomen. A laparoscope, a thin tube equipped with a camera, is inserted through one incision to provide a magnified view of the internal organs on a monitor. Specialized tools are then introduced through the other small ports, allowing the surgeon to use sharp dissection, electrocautery, or advanced energy devices to meticulously cut the scar tissue.
Open surgery, known as laparotomy, involves a larger incision and is reserved for cases with very dense, widespread adhesions or when an urgent bowel obstruction requires immediate, extensive intervention. While an open approach provides direct visual and tactile access for the surgeon, it is associated with a longer recovery time and an increased risk of creating new adhesions. Regardless of the technique, the procedure demands careful technique to avoid inadvertent injury to adjacent structures like the bowel.
Recovery and Managing Recurrence
The recovery period following lysis of adhesions varies depending on the surgical technique used. Patients who undergo laparoscopic adhesiolysis experience a quicker recovery, often returning to regular activities within two to four weeks. Conversely, an open laparotomy, due to the larger incision, requires a longer hospital stay and an extended recovery timeline.
A notable challenge with adhesiolysis is the risk of recurrence, as the surgical process itself involves tissue manipulation that can trigger the body’s natural healing response to form new scar tissue. To combat this, surgeons may apply barrier agents, such as specialized films or gels, directly onto the delicate tissue surfaces before closing the incision. These temporary barriers are designed to keep the healing surfaces separate, reducing the chance of them sticking together again. While the procedure offers potential for pain relief and resolution of obstruction, managing this long-term risk of recurrence remains a focus of post-operative care.