Lysis of adhesions is a surgical procedure performed to separate and remove abnormal bands of scar tissue that form inside the body. Adhesions often develop as a result of the body’s natural healing response to internal trauma, infection, or inflammation. The procedure is necessary when these bands begin to tether organs, causing pain or restricting normal function. Most frequently, this condition follows previous abdominal or pelvic surgery, leading to potentially serious complications.
Understanding Adhesions: Formation and Impact
Adhesions are essentially internal scar tissue, ranging from thin, filmy sheets to thick, rope-like bands of collagen. They form when the body’s repair mechanism responds to tissue injury by depositing excess collagen and fibrin, causing surfaces that should move freely to stick together. The most common locations for these to form are the abdominal cavity and the pelvis.
Surgical procedures are the predominant cause of adhesions. Non-surgical causes also exist, including intra-abdominal infections like peritonitis or appendicitis, as well as inflammatory conditions such as endometriosis. Regardless of the cause, the bands tether organs like the intestines, bladder, or reproductive organs, preventing their natural movement.
This tethering can lead to significant anatomical and physiological consequences. When the small intestine is involved, for example, the adhesion can cause the bowel to kink or twist. This mechanical constriction can impede the flow of contents through the digestive tract, resulting in the most life-threatening complication.
Recognizing the Need for Intervention
While many adhesions remain symptomless, others cause chronic abdominal or pelvic pain that can be persistent or intermittent. This discomfort often results from the pulling or stretching of the organs as the patient moves, or from the intestine trying to push contents past a narrowed segment. Adhesions are also a frequent cause of infertility in women, as pelvic adhesions can distort the anatomy of the fallopian tubes and ovaries.
The most serious presentation that necessitates intervention is a small bowel obstruction (SBO), which is frequently caused by adhesions in adults. Symptoms of an SBO include severe, cramping abdominal pain, bloating, nausea, and an inability to pass gas or stool. A complete obstruction is a medical emergency that requires immediate treatment to prevent long-term damage to the bowel.
Diagnosis relies primarily on a detailed patient history, especially one involving previous abdominal or pelvic surgery. Imaging, such as a CT scan, cannot typically visualize the adhesions, but it is highly effective at detecting the resulting intestinal obstruction. Surgical intervention is generally recommended when the adhesions cause debilitating chronic pain, fertility impairment, or a dangerous bowel blockage.
The Surgical Procedure: Techniques of Lysis
Adhesiolysis involves the careful division or cutting of the fibrous bands to free the stuck organs. The two main surgical techniques used are laparoscopic and open surgery, with the choice depending on the complexity of the adhesions and the patient’s overall condition. Laparoscopic adhesiolysis is a minimally invasive approach that is generally preferred due to its association with lower rates of major complications and shorter hospital stays.
During a laparoscopic procedure, the surgeon makes several small incisions in the abdomen, through which a camera and specialized instruments are inserted. Carbon dioxide gas is used to inflate the abdomen, creating a working space and improving visibility for the surgeon. The surgeon then uses sharp or blunt dissection, sometimes with energy devices, to meticulously cut the adhesive bands and restore the organs to their natural positions.
Open surgery, or laparotomy, involves a larger incision in the abdomen and is often necessary in cases of extensive, dense adhesions or a complete bowel obstruction. The primary risk of adhesiolysis, regardless of technique, is accidental injury to the surrounding organs, most commonly the bowel. The risk of iatrogenic bowel perforation is a significant concern, especially when the adhesions are matted and difficult to separate from the intestinal wall.
Post-Operative Care and Preventing Recurrence
Following the procedure, post-operative care focuses on pain management and careful monitoring of the patient for complications. Patients who undergo laparoscopic lysis generally experience a quicker recovery, with reduced pain and a shorter length of hospital stay compared to open surgery. Activity restrictions are common in the initial recovery period to allow the surgical sites to heal properly.
The biggest challenge after adhesiolysis is the high probability of recurrence, as the surgery itself can create new trauma that triggers the formation of new scar tissue. To mitigate this, surgeons often employ adhesion barriers at the end of the operation. These barriers are typically absorbable films or gels placed between the healing surfaces.
The barrier acts as a temporary physical separation, preventing contact between the injured tissues during the first week of healing when new adhesions are most likely to form. While these preventive measures aim to reduce the risk, patients must remain aware that the potential for new adhesions and related symptoms remains a lifelong possibility.