When abdominal surgery or inflammation occurs, the body’s natural healing process can sometimes lead to the formation of internal scar tissue known as adhesions. These fibrous bands can connect internal organs that are normally separate, such as loops of the intestine or the bowel, to the abdominal wall. While many people with abdominal adhesions have no symptoms, these bands can eventually cause significant health problems. Surgical intervention is required when adhesions begin to interfere with normal bodily function, particularly in the digestive system.
The Specific Term for Freeing Intestinal Adhesions
The medical procedure for surgically freeing or dividing internal scar tissue is called Adhesiolysis. This term is derived from two Greek root words: “adhesio,” meaning to stick to, and “lysis,” meaning to separate or free. When the procedure specifically focuses on the bowel or intestines, it may be referred to as Enterolysis.
This surgical intervention cuts and separates the fibrous bands of scar tissue to restore the normal, unattached state of the internal organs. The goal is to eliminate the physical connections that are causing pain, obstruction, or other related complications.
What Are Intestinal Adhesions and Why Are They Problematic?
Intestinal adhesions are bands of scar tissue that form between abdominal tissues and organs, causing them to stick together. These bands can vary from thin, veil-like sheets to thick, dense fibrous cords. Scar tissue formation is a normal part of the body’s repair mechanism following trauma.
The most frequent cause of abdominal adhesions is previous abdominal or pelvic surgery, with almost everyone who undergoes such a procedure developing some degree of scarring. Other causes include inflammation from conditions like appendicitis, gynecological infections, or radiation treatment. Although most adhesions are asymptomatic, they become problematic by kinking, twisting, or pulling the intestines out of their natural position.
The main clinical concern caused by problematic adhesions is a Small Bowel Obstruction (SBO), where the scar tissue partially or completely blocks the passage of food and stool. A complete obstruction is a medical emergency. Even partial blockages can cause chronic, cramping abdominal pain, bloating, nausea, and vomiting as the intestine attempts to force contents past the narrowed segment.
How Adhesiolysis Procedures Are Performed
Adhesiolysis procedures are performed using one of two surgical methods: a minimally invasive approach or an open operation. The choice depends on the complexity and extent of the adhesions, as well as the patient’s overall health. The surgeon aims to divide the scar tissue without causing injury to the underlying organs, which is a challenge when the tissue is densely matted.
Laparoscopic Adhesiolysis
Laparoscopic Adhesiolysis is the preferred minimally invasive technique, involving a few small incisions in the abdomen. A laparoscope, a thin instrument with a camera and light, is inserted through one incision, and specialized surgical tools are passed through the others. The surgeon uses these tools to carefully inspect and cut the adhesions, separating the stuck tissues. Benefits include less postoperative pain, shorter hospital stays, and a reduced risk of new adhesion formation compared to open surgery.
Open Adhesiolysis
Open Adhesiolysis, or laparotomy, involves making a single, larger incision in the abdomen to gain direct access to the organs. This method is often necessary when the patient presents with a complicated or severe intestinal obstruction, or if the adhesions are too widespread and dense for the laparoscopic approach. While it provides direct tactile feedback, it is associated with a longer recovery period and a higher likelihood of future adhesion recurrence. The surgeon meticulously identifies and divides all bands of scar tissue using instruments like scissors or specialized energy devices.
Recovery and Reducing the Risk of Recurrence
The recovery timeline following adhesiolysis is influenced by the surgical technique used. Patients who undergo laparoscopic adhesiolysis often have a shorter hospital stay, sometimes being discharged within 24 hours. Those who require an open procedure may need to remain hospitalized for two to five days to manage pain and monitor for complications. Post-operative care involves managing pain with medication and a gradual progression back to a normal diet, particularly if the surgery resolved an obstruction.
A primary concern after this procedure is the risk of recurrence, as the surgical process itself can trigger the formation of new adhesions. Post-operative adhesions can reform, potentially leading to future obstructions or chronic pain. To combat this, surgeons employ anti-adhesion strategies during the initial operation.
Preventative measures include the use of physical barriers, such as specialized gels, films, or sheets, placed between healing tissue surfaces. These materials, often composed of substances like sodium hyaluronate and carboxymethylcellulose, act as a temporary spacer to keep tissues from sticking together while they heal. Meticulous surgical technique, which involves minimizing tissue handling and preventing tissue from drying out, is also a fundamental strategy for reducing the risk of adhesion formation.