Adhesiolysis

At the Vital Health we have successfully treated hundreds of patients with severe adhesions, and for some their surgery was not only life changing but life saving. Our adhesion patients are offered the same ongoing follow-up care as our endometriosis patients.

What are adhesions?

Adhesions are bands of scar tissue that form between adjoining organs and structures, causing them to fuse together. Adhesions can be thin like cobwebs or thick and dense like hardened glue. Adhesions can result from disease (such as endometriosis), infection (such as pelvic inflammatory disease), injury (such as following abdominal surgery) or may have no known cause (idiopathic adhesions).

Pelvic Adhesions

When pelvic adhesions occur they can cause a range of symptoms depending on the organs and tissues that are involved. If the ovaries are involved by scarring or are adhered to the pelvic side walls, the presence of a cyst in the ovary can cause the adhesions to stretch, resulting in a painful, pulling sensation. If the intestines are involved by adhesions, this may result in severe cramping pains due to restricted motility of the gut, and if a section of bowel is constricted by an adhesion, partial or complete bowel obstruction can result, causing severe pain, nausea and vomiting, constipation and diarrhea. In severe cases of adhesions the pelvis may become “frozen” by extensive dense adhesions, fusing the bladder to the uterus, the uterus to the large bowel, and the ovaries and tubes to the bowel, pelvic sidewalls and uterus. In rare cases the entire abdominal cavity, containing the reproductive organs and intestines, will be obliterated by severe adhesions, distorting the pelvic anatomy and making it impossible for the surgeon to identify the pelvic organs without first conducting an extensive and painstaking dissection of the adhesions.

I have been dealing with this problem for 27 years. I have tried not to let it slow me down but as I age it does get a little more difficult. I feel really encouraged that there is really a better answer for me than “you need to live with it”.Carolyn T.

How are adhesions treated?

There are no non-invasive medicines or treatments that destroy or break down pelvic adhesions, although massage and physical therapy may help stretch and loosen adhesions, mobilizing organs. Surgery is currently the only treatment that can effectively remove adhesions. A problem with this treatment, however, is that surgery itself can contribute to the formation of new adhesions. For this reason it requires a high level of expertise and special techniques to surgically treat adhesions while minimizing the risk of recurrence.

Patients with severe endometriosis will have a significant amount of scar tissue and adhesions that have resulted from the inflammatory disease process. In order to prevent these adhesions from recurring following surgery it is essential that all areas of disease are fully removed. If the adhesions are treated but the disease is left in situ, the inflammatory process will continue and new adhesions will likely form in time. Once the disease has been fully removed, various measures can be taken to prevent post-operative adhesions from forming.

Adhesion surgery techniques

Regardless of the cause of your adhesions, various techniques can be used to remove adhesions, restore your pelvic anatomy, alleviate adhesion-related pain and prevent recurrence.

The first step of adhesion surgery is a process called adhesiolysis. This is the process of dissection (to cut apart or separate) structures that have been fused by adhesions. In order to carefully remove all adhesions and scarring without causing damage to the pelvic structures, advanced laparoscopic surgical skills and an extensive knowledge of the pelvic anatomy are required. Once all adhesions have been carefully separated the patient will typically be left with multiple areas of raw tissue. If these areas are left as they are, adjacent structures may stick to these raw areas resulting in new adhesions. This process typically occurs during the first hours and days following surgery, and these newly formed adhesions may then go on to thicken and tighten during the months thereafter. This is the body’s natural healing response to “injury,” although some people have a greater tendency to form scar tissue and adhesions than others.

In order to prevent recurrence following adhesiolysis adhesion barriers can be placed over raw areas of tissue to protect them while the tissue heals. The barriers biodegrade during the course of a few weeks by which point healing has sufficiently progressed. Dr. Cook has had good success with INTERCEED, which is a cellulose membrane adhesion barrier. Results with this barrier vary significantly between physicians, with some even reporting an increase in post-operative adhesions following its use. For this reason it is important to ask your physician about his or her own clinical results. The reason physicians are getting mixed results with INTERCEED is because the material should only be used on bloodless tissue and sufficient barriers should be used to cover all areas of raw tissue. If bleeding is not adequately controlled prior to placement of the sheeting and if the sheets are not placed carefully and thoroughly over all areas of raw tissue, adhesions may result. Dr. Cook, however, has ongoing experience with INTERCEED with excellent results. Our meticulous patient follow-up enables us to keep close track of our post-operative outcomes following adhesion surgery and the use of INTERCEED.

If adhesions are present between the ovaries and adjacent structures, temporary suspension of the ovaries by suturing them out of the way of nearby raw surfaces can help prevent them from re-adhering in the previous position. The sutures can then be released a week after surgery.

In cases of severe adhesions a special surgical technique called Early Second Look Laparoscopy (ESLL) may be recommended. This is the practice of reoperating on the patient a week following her first surgery. Given post-operative adhesions tend to form during the first days following surgery, taking a second look a week later gives the surgeon the chance to take down any fresh adhesions before they become established. Initially new adhesions are typically thin and wispy, thickening over time. By disrupting the healing process and taking down these fresh adhesions, the risk of recurrence of adhesions is reduced. Adhesion barriers are then re-applied to any areas where adhesions have formed.

If pain persists, a Patient Assisted Laparoscopy (PAL) may be recommended. This is where the patient is sedated but conscious during the first part of surgery. The surgeon carefully and gently probes the pelvic structures with a laparoscopic instrument and the patient tells the surgeon if and when he identifies the locations that replicate her pain. If scarring or adhesions are found to trigger the pain, these will then be removed after the patient has been placed under general anesthesia.

Hope for women with adhesion-related pain

If you think you may be suffering from adhesion-related pain, there is hope! Expert laparoscopic removal of your adhesions combined with the careful use of adhesion barriers and, if indicated, an early second look procedure can help provide long-term relief and prevent recurrence.