Adhesiolysis

Adhesiolysis

An adhesion is a strip of scar tissue that occurs as part of the natural healing process of the body to tissue disturbances. Such disturbances can occur due to:

• Surgical intervention
• infections
• trauma
• Exposure to radiation
• Pathological processes like endometriosis

Although adhesion formation is a normal process in healing, excessive scar tissue can on occasion form beyond the initial trauma and cause problems. Adhesions can stick organs or tissues together, causing pain, organ dysfunction, or more serious health complications, including bowel obstruction. Adhesions can be seen as thin, avascular sheets of plastic wrap or as thick, vascularized fibrous bands, the latter being more serious and difficult to reverse.

Adhesiolysis: Surgical Treatment for Adhesions

Adhesiolysis is a surgical technique to excise or cut adhesions, normalizing anatomy and organ function while also eliminating concomitant pain. While most adhesions are secondary to trauma, they do occasionally occur without evident tissue damage.

Symptoms of Adhesions

Most patients with adhesions show little to no symptoms. However, severe adhesions result in pain and impairment of functions by trapping the nerves or constraining tissues. The following symptoms are usually shown:

• Pain in the epigastric region or beneath the liver when deep breathing occurs
• Pain from intestines or obstructive pain that arises on performing exercises or on stretching
• Pain during intercourse due to vaginal or uterine adhesions
• Chronic pelvic pain
• Partial or complete loss of organ function in extreme cases
• Ovulatory dysfunction when adhesions involve the ovaries
• Reduced fertility
• Reduced fertility

Diagnosis of Adhesions

Diagnosis of adhesions is based on clinical presentation and imaging examinations. Standard X-rays might show small obstructions, but other tests would be required if pain is the main symptom with no apparent obstruction. Diagnostic tests include:

• Endoscopic tests (e.g., endoscopy, colonoscopy, hysteroscopy, sigmoidoscopy, proctoscopy) for strictures detection
• Magnetic Resonance Imaging (MRI) for clear visualization
• Videolaparoscopic surgical exploration for absolute diagnosis when other techniques are non-diagnostic

Prevention of Adhesions

At present, prevention of adhesions is not possible in a definitive manner. Nevertheless, according to some research, the use of adhesion barrier products like SepraFilm and Intercede has been shown to prevent their formation in some clinical contexts.

Treatment of Adhesions (Videolaparoscopic Approach)

Adhesions in the abdominal cavity can be successfully treated through videolaparoscopic means. Adhesiolysis, or enterolysis when undertaken close to the intestines, may be performed as an independent procedure or alongside other operations, like ovarian cyst or fibroid resection.

It is generally believed that adhesions are a contraindication to videolaparoscopy. In fact, laparoscopic surgery has several benefits over open surgery (laparotomy), such as:

• Better visual and magnification of adhesions and impacted organs
• CO2 gas insufflation, which naturally separates abdominal organs, enabling accurate adhesion identification and removal
• Lower risk of postoperative adhesion formation due to minimally invasive microsurgical procedures.

Recovery and Candidacy for Adhesiolysis

Recovery from adhesiolysis is generally rapid, with most patients being discharged within 24 hours and returning to normal activities within one to two weeks. Whether a patient is a good candidate for adhesiolysis needs to be assessed on an individual basis, taking into account the severity of symptoms and general health status.

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