Adhesions
|
Adhesion is the medical term for scar tissue. You can find a detailed discussion about the diagnosis and treatment of adhesions in the Ask Dr. Cook Archives. Many endometriosis patients have adhesions, or scar tissue. Use of the Carbon 13 CO2 laser is ideal for treating adhesions. I also see and treat patients with extensive adhesions who do not have endometriosis. Many physicians believe, and thus patients are told, that if they have adhesions they should not have surgery, because it will make them worse. While it is possible for the scar tissue to return in full, in my experience, this is the exception rather than the rule. With the techniques that I use, most patients have a marked reduction in adhesion formation. It is possible to reduce the amount of scar tissue, or even eliminate it surgically. If there is any question if the adhesions are causing pain, a Patient Assisted Laparoscopy (PAL) or "conscious pain mapping" can be performed. This procedure is performed in the operating room with the patient awake. Along with a 2-millimeter laparoscope, I use a 2-millimeter probe to palpate different areas inside of the patient's body. When tugging on the adhesion with the probe reproduces her pain, a diagnosis of adhesion-related pain can be confirmed. Overall, a patient undergoing minimally invasive surgery will have less adhesion formation or reformation than a patient undergoing the same procedure through a large laparotomy incision. Still, even with the use of good laparoscopic surgical technique and the gentle handling of the tissues, if a patient has fairly extensive adhesions the chances of a significant portion of them reforming after surgery is relatively high. In these cases I also employ an Early Second Look Laparoscopy (ESLL) to help reduce the extent and severity of post-op adhesion formation. Postoperative adhesions can begin forming hours after the completion of the surgery. Almost all adhesions that are going to form post-op will begin within seven days of the surgery. Although present, the adhesions are initially not strong. It takes weeks and months for the adhesions to strengthen and shorten, potentially causing pain. One week after the initial surgery adhesions that are going to form are present, and some of the post-operative inflammation has decreased. I perform an ESLL about a week after the initial surgery to remove the adhesions before they have strengthened. I use a combination of gentle traction and hydro-dissection (gentle water pressure) to separate the adhesions. Afterwards the adhesions can reform, but on average they seem to be smaller in size and less dense. |
