Adhesions are bands of internal scar tissue that can form within the body, causing organs and tissues that are normally separate to stick together. These fibrous connections commonly develop in the abdomen and pelvis, but can also appear around the heart, lungs, spine, joints, or eyes. Lysis of adhesions is a surgical procedure designed to release these adhered tissues, restoring their natural movement and function.
What Are Adhesions?
Adhesions are bands of fibrous tissue that form between tissues and organs not typically connected. They are internal scar tissue, appearing as thin sheets or thick bands. Normally, internal organs have smooth, slippery surfaces that allow them to glide. Adhesions cause these surfaces to stick together, restricting normal organ mobility.
These bands commonly develop in response to the body’s natural healing process following internal irritation or injury. Prior surgeries, especially abdominal procedures, are the most frequent cause. Adhesions can also arise from inflammation or infection, such as appendicitis, endometriosis, pelvic inflammatory disease, or diverticular disease. Physical trauma or radiation therapy can similarly trigger their development.
Understanding Lysis of Adhesions
Lysis of adhesions refers to a surgical procedure that addresses abnormal internal scar tissue. The term “lysis” comes from a Greek word meaning “to loosen” or “to separate,” and in this medical context, it means the surgical cutting or burning away of adhesion bands.
The goal of this procedure is to separate abnormally connected tissues or organs. By releasing these adhered structures, surgeons aim to restore normal anatomical relationships and organ functions. This intervention alleviates symptoms and complications, enabling organs to move freely.
How Lysis of Adhesions is Performed
Lysis of adhesions is performed using two surgical approaches: laparoscopic surgery or open surgery. The choice depends on the extent and location of the adhesions, as well as patient-specific factors. Both procedures begin with general anesthesia, ensuring the patient is asleep.
In laparoscopic, or minimally invasive, surgery, the surgeon makes several small incisions in the abdomen. A long, thin, lighted tube with a camera, called a laparoscope, is inserted through one of these incisions, transmitting images to a monitor. Carbon dioxide gas is often introduced into the abdominal cavity to inflate it, creating more space for the surgeon to visualize and work. Additional small incisions allow for the insertion of specialized surgical instruments, which are used to carefully cut, separate, or remove the adhesion bands. Techniques involve gentle dissection using scissors, cautery devices, or a laser, with a focus on minimizing trauma to surrounding tissues.
Open surgery involves a larger incision in the abdomen, providing the surgeon with a direct view of the internal organs. This approach is often used for more complex or widespread adhesions, or if laparoscopic access is challenging due to extensive prior surgeries. Once the abdominal cavity is open, the surgeon manually identifies and carefully dissects the adhesions, freeing the organs. Regardless of the approach, meticulous attention is given to controlling any bleeding during the dissection process.
When Lysis of Adhesions is Considered
Lysis of adhesions is considered when these fibrous bands cause significant symptoms or complications. While many adhesions do not cause problems, some can lead to considerable discomfort and dysfunction. The decision to perform the procedure is made when adhesions are directly linked to specific medical issues.
One common reason for intervention is chronic abdominal or pelvic pain that cannot be managed by other means. Adhesions can pull on nerves or organs, leading to persistent discomfort. Another frequent indication is bowel obstruction, where adhesions kink, twist, or compress parts of the intestines, impeding the passage of food and waste. This can be a life-threatening condition requiring urgent attention. In women, pelvic adhesions can contribute to infertility by affecting the normal function of reproductive organs, such as the fallopian tubes or ovaries, preventing egg and sperm from meeting. The procedure may also be considered to restore proper organ function or prepare for other surgical procedures.
Post-Procedure Expectations
Following lysis of adhesions, patients can expect a recovery period during which they may experience some discomfort. Immediately after the procedure, common sensations include abdominal pain, fatigue, nausea, and temporary irregularities in bowel movements. Pain management strategies are provided to help alleviate these symptoms.
The duration of hospital stay varies, with laparoscopic procedures often allowing for discharge within a day or two, while open surgery may require a few days to a week. Most individuals can gradually return to their regular activities within two to four weeks, though full recovery, including the normalization of bowel function, may take several weeks. It is important to avoid strenuous activities during the initial recovery phase to promote proper healing. While the procedure aims to resolve issues caused by adhesions, it is important to understand that new adhesions can sometimes form after surgery, a natural part of the body’s healing response to surgical intervention.