The freeing of intestinal adhesions is a procedure addressing internal scarring that often follows abdominal or pelvic surgery. This surgical intervention becomes necessary when these fibrous bands of tissue cause pain or dysfunction, particularly concerning the digestive tract.
Intestinal Adhesions: Formation and Impact
Intestinal adhesions are abnormal bands of scar tissue that form between organs or between organs and the abdominal wall, causing structures that should move freely to stick together. The formation of these fibrous bands is the body’s natural response to trauma or injury to the peritoneal surface. The vast majority of abdominal adhesions, up to 95% of cases, develop following abdominal surgery, though they can also result from conditions like infection, inflammation, or radiation.
While many adhesions remain harmless, they can cause significant problems by kinking, twisting, or tethering the intestines. This abnormal binding can lead to chronic abdominal pain by limiting the natural mobility of the organs, or, more seriously, it can cause a partial or complete intestinal obstruction. Intestinal obstruction is a serious complication where the passage of food and stool is restricted, requiring immediate medical attention. Adhesions are the most common cause of small bowel obstruction in Western countries, accounting for approximately 60% of cases.
The Specific Surgical Procedure
The medical term for the surgical procedure to free or remove intestinal adhesions is adhesiolysis, also referred to as lysis of adhesions. This term, derived from the Greek words meaning “to loosen,” specifically describes the division of the abnormal scar tissue. The goal of this procedure is to restore the normal anatomical relationships and mobility of the abdominal organs, especially the intestines.
By dividing the bands of scar tissue, the surgeon aims to relieve the tension and obstruction that may be causing pain or preventing the normal flow of digested contents. Adhesiolysis is a complex procedure because the scar tissue often warps the normal anatomy, making it challenging to separate the adhesions without injuring the underlying bowel.
Surgical Approaches: Methods of Adhesiolysis
Surgeons can choose between two primary methods for performing adhesiolysis: a minimally invasive approach known as laparoscopic adhesiolysis, or a more traditional method called open adhesiolysis. The choice of approach is determined by factors such as the extent and density of the adhesions, the patient’s overall health, and whether the procedure is being performed emergently for a bowel obstruction.
Laparoscopic Adhesiolysis
Laparoscopic adhesiolysis is often the preferred initial approach, as it involves several small incisions through which a camera and specialized instruments are inserted. This minimally invasive technique is associated with reduced post-operative pain, shorter hospital stays, and a lower risk of new adhesion formation compared to open surgery. This allows the surgeon to visualize and divide the adhesions using instruments like scissors or advanced energy devices.
Open Adhesiolysis
Open adhesiolysis, or laparotomy, is performed through a single, larger incision, typically down the midline of the abdomen. This approach provides the surgeon with direct tactile feedback and greater access. Open surgery is often necessary when dealing with very dense, widespread, or complex adhesions, or in emergency cases where a bowel perforation is suspected. In some cases, a laparoscopic procedure may need to be converted to an open one if the adhesions are too extensive or the risk of bowel injury becomes too high.
Post-Operative Care and Recurrence Management
Following adhesiolysis, post-operative care focuses on managing pain and ensuring the safe recovery of bowel function. Patients are closely monitored for complications and typically receive intravenous fluids and pain medication in the initial recovery period. The diet is slowly advanced, beginning with clear liquids and progressing to solid foods once the patient demonstrates normal bowel function.
A significant challenge following adhesiolysis is the high probability of adhesion recurrence, as the surgical act of dividing the scar tissue itself can trigger the formation of new adhesions. Surgeons employ several strategies to minimize this risk, including meticulous surgical technique, such as gentle handling of tissues and minimizing the use of thermal energy. Barrier agents, such as film-like materials or specialized solutions, may be placed between vulnerable tissues before the incision is closed to physically separate the healing surfaces. Careful patient selection and the use of the laparoscopic approach are also important components in preventing the cycle of adhesion formation and recurrence.