home Outer What you need to do to avoid adhesions. Postoperative adhesions: causes, symptoms and treatment. Removal of adhesions after abdominal surgery

What you need to do to avoid adhesions. Postoperative adhesions: causes, symptoms and treatment. Removal of adhesions after abdominal surgery

Many people had to undergo various operations. However, not everyone knows what adhesions are after surgery.

Postoperative adhesions are connective tissue masses in the abdominal or pelvic region that connect internal organs. They act as protection and limit the focus of inflammation. Adhesions after surgery lead to disruption of the internal organs.

In a normal state, the internal organs are covered with a slippery membrane, which prevents them from sticking to each other. Adhesion appears after surgery. Clinical manifestations depend on the number and location of adhesions. Treatment can only be performed surgically.

Adhesions form after surgery as a response to an inflammatory response. They connect adjacent organs or intestinal loops.

The main reasons for the appearance of strands are:

surgical interventions;
inflammation of the appendix and appendectomy;
abortion;
hemorrhage into the abdominal cavity;
endometriosis;
inflammatory diseases.

The main reason is surgery, but there are other risk factors:

Abdominal contusions. As a result, hemorrhage may occur.
Abdominal obesity. Excess fatty tissue forms a large omentum that closes the intestinal loops. Loose omentum tissue is especially sensitive to the appearance of strands.
Congenital abnormalities of the abdominal organs.
Ingress of chemicals. This usually happens at the time of the operation, particles of gauze, iodine or other chemicals get inside. Because of this, adhesions may also appear after surgery.

Postoperative adhesions are also formed due to the ingress of foreign objects.

Why are adhesions dangerous?

Normally, the organs in the abdominal and pelvic regions are mobile. Intestinal loops can move during digestion. During pregnancy, an enlarged uterus does not negatively affect the bladder.

The resulting scars impair the mobility of internal organs. Adhesive disease is dangerous by the development of intestinal obstruction. This can lead to infertility in women. In some cases, adhesions may not cause discomfort to the patient. However, most often the patient is worried about the pain syndrome.

Clinical picture

The duration of adhesion formation depends on the affected organ. Usually the patient is worried about pain in the area of \u200b\u200bthe surgical scar.

The most common symptoms are:

nausea, vomiting;
diarrhea or constipation;
pain on palpation in the seam area;
increased body temperature;
dyspnea;
hyperemia in the area of \u200b\u200bthe scar.

There are no symptoms at first. However, with the progression of the process, pulling pains appear. In some cases, pain occurs with a deep breath. If adhesions develop in the pelvic region, then pain in a woman can be observed during intercourse.

Very often, an adhesive process appears between adjacent organs. Paroxysmal pains that are not relieved by taking antispasmodic drugs are a cause for concern. After some time, after the onset of symptoms, the person becomes irritable. Three forms of pathology are officially distinguished:

The acute form is characterized by severe pain syndrome. Shortness of breath increases, body temperature rises. When trying to palpate the area, a sharp pain appears. Leads to acute intestinal obstruction and renal failure.
Chronic form - if the pathology appears in the pelvic region, then the symptoms are similar to premenstrual syndrome. Disruption of the bowel and bladder may occur. Pain syndrome appears when changing body position and sexual intercourse.
Intermittent form - characterized by symptoms in the work of the gastrointestinal tract. Constipation is replaced by diarrhea and vice versa.

In addition to pain syndrome, headaches and general malaise appear.

Diagnostic methods

If symptoms appear, the patient should see a specialist. First, the patient is examined and anamnesis is taken. Diagnosis of the disease should be comprehensive.

Analyzes

First of all, the patient needs to be tested.

Complete blood count - prescribed for any disease. The analysis can show the presence of inflammatory processes, as well as the general condition of the body. With adhesive disease, there is leukocytosis, which indicates an inflammatory process in the body. There is also anemia.
Biochemical blood test - can tell about the work of internal organs, especially the liver and kidneys. There are abnormalities: elevated urea, low hemoglobin, and C-reactive protein (in acute inflammation).

Stool analysis may be required if an intestinal obstruction is suspected. Additional tests may include a blood test for hormones and semen analysis.

Instrumental diagnostic methods

The main diagnostic methods are instrumental studies. They are more informative than analyzes. If adhesions are suspected after surgery, the following studies are prescribed:

Ultrasound - the study shows the presence of adhesions;
CT is the most informative method;
radiography with a contrast agent - before the procedure, you need to drink a special solution, which, when taken, shows disturbances in the functioning of the intestines and other complications;
laparoscopy - a small incision is made in the abdomen and then a tube with a camera and lighting is placed. This allows diagnostics from the inside.

After carrying out instrumental diagnostics, the doctor can prescribe treatment or send for additional examination.

Differential diagnosis

Adhesive disease can be easily confused with diseases of the internal organs, since many clinical symptoms are similar. You need to know how to distinguish adhesions from another disease:

pinched hernia - characterized by protrusion, pain and tension in the affected area;
acute pancreatitis and cholecystitis - indomitable nausea and vomiting, fever, pain of a girdle nature;
gastrointestinal ulcer - paroxysmal pain in the abdominal region;
acute appendicitis - pain in the right iliac region. High body temperature and an increase in leukocytes in the blood;
torsion of the ovarian cyst - paroxysmal pain in the lower abdomen.

Such a diagnosis is carried out when adhesions are suspected. Diagnostics should be comprehensive and after the diagnosis is clarified, treatment is prescribed.

Treatment

You need to know how to treat adhesions after surgery. If they have just begun to form, then they can be easily eliminated with timely treatment. Over time, the adhesions become coarser and more like scars or scars.

Operative intervention

In chronic forms of adhesive disease, surgical intervention is necessary. Adhesions are removed under general anesthesia.

Laparotomy (surgery through an incision in the abdominal wall) and laparoscopy (surgery through punctures).
Excision of adhesions with a laser or an electric knife.

The operation removes adhesions, but this does not guarantee the exclusion of relapses. The more surgical operations are performed, the higher the likelihood of developing adhesive disease.

Drug treatment

In the early stages, drugs can be used. Enzyme therapy is performed for the introduction of split enzymes into the body, injected intramuscularly. For topical use, anti-inflammatory ointments are well suited.

Physiotherapy

Physiotherapy is especially effective for adhesions in the pelvic area. The following procedures are carried out:

Physiotherapy can be used in advanced stages of the disease. They contribute to the elimination of the inflammatory process and pain.

Prevention

To avoid the development of the adhesive process, the patient needs to follow the recommendations given by the doctor after the operation. A couple of days after the operation, the patient needs to restore physical activity. Even minor movements act on the internal organs like a massage, which prevents them from sticking together. The combination of physical activity and special massage will help to avoid the formation of adhesions after surgery. It is easier to carry out prophylaxis, so that later on wondering how to remove adhesions after surgery.

Adhesive disease is the appearance of adhesions after surgery (areas of fibrous tissue) formed between the mucous membrane of the inner wall of the abdominal membrane (parietal peritoneum) and the loops of the small and large intestine or other organs of the abdominal cavity: gallbladder, liver, bladder, ovaries, uterus.

In a normal state, the organs of the abdominal cavity and their walls are covered with a slippery peritoneum, which prevents them from sticking to each other. Adhesions appear after interventions in organ tissue. The symptoms of postoperative adhesions will depend on their number and location. Adhesions can only be treated surgically.

How adhesions hurt and the reasons for their appearance

The most common cause of the adhesion formation process is operations on the abdominal organs. Almost everyone patients (about 95%) develop adhesive disease after surgery on the abdominal organs.

Adhesions can thicken and grow in size over time, creating certain problems many years after surgery.

Reasons for the formation of adhesions during operations:

In rare cases caused by inflammation, the appearance of which is not associated with the operation.

These reasons include:

Performing radiation therapy for the treatment of cancer.
Appendicitis.
Infectious diseases of the internal organs of the abdominal cavity.
Gynecological diseases, for example, adhesions after removal of the uterus.
Adhesions after laparoscopy.

In rare cases, adhesive disease appears for no apparent reason.

Adhesion mechanism

The loops of the large and small intestine under normal conditions inside the abdominal cavity can freely move, sliding, relative to each other and to the rest of the adjacent organs. This sliding is created by the peritoneum and its thin lubricating film.

During damage to the tissues of the abdominal cavity, an inflammation process appears, in the area of \u200b\u200bwhich there is connective fibrous tissuefrom which the seals are formed. With the development of adhesions, the intestine will no longer be able to move freely along the abdominal cavity, since its loops are interconnected, with the abdominal wall or with other abdominal organs.

In the areas of adhesion formation, the intestine can twist around the axis, because of this, the normal passage of food or blood supply is disrupted. Often this happens to the small intestine. Twisting is usually temporary, but in some cases it may not spontaneously recover.

Adhesions: Symptoms of the appearance

Doctors associate signs and symptoms of adhesive disease not with adhesions directly, but with the problems that they cause. People note different complaints, based on where the adhesions appeared and the work of which organs they violated. Most often, adhesions do not cause any symptoms, as they are simply not detected.

With adhesive disease, abdominal pain occurs as a result of tension on the nerves within the adhesions themselves or in the abdominal organs.

Symptoms of the adhesions in the abdominal cavity:

Intestinal obstruction, which is caused by adhesive disease, may require urgent surgery. Intestinal adhesions can cause cramping, wave-like pain in the abdomen, which can last for several seconds and worsen after eating, as it increases the activity of the digestive system.

After the onset of pain, the patient may vomit, relieving his condition. The patient gradually bloating appears, a person can hear a slight rumbling in the intestines, accompanied by loose stools and flatulence, and the temperature also increases.

Intestinal adhesive obstruction can go away on its own. But the patient needs to see a doctor when the pathology progresses, and the following symptoms appear:

Constant and severe pain.
Great distension of the intestines.
The disappearance of bowel movements and gas discharge.
Disappearance of sounds of intestinal peristalsis.
Strong increase in body temperature.
The abdomen increases in size.

The subsequent progression of adhesive disease can lead to rupture of the intestinal wall and contamination of the abdominal cavity with its contents.

Adhesions when removing the uterus

When the uterus is removed, the symptoms of the appearance of adhesions in the female body are manifold, since it is quite complex surgical intervention... In gynecology, postoperative female adhesions occur in most patients. The appearance of adhesive processes is due to many factors:

The main symptoms of uterine adhesions are expressed in the form of disturbances in the processes of defecation and urination, lower abdominal pain, as well as failures in the functioning of the digestive tract. Anticoagulants and antibiotics are prescribed to minimize the risk of uterine adhesions. Physical therapy and physical activity are also recommended.

Diagnosis

Adhesions cannot be detected using X-ray methods or ultrasound examination. Many of them are defined with surgical intervention. But nevertheless, computed tomography, irrigoscopy and radiography of the abdominal cavity can help diagnose their formation.

How are adhesions treated?

Adhesions that are not causing complaints, do not need any treatment. There are no conservative treatments for adhesions.

Treatment of adhesions will depend on the degree of formation and location of adhesions and the causes of occurrence. Often, the patient does not have any pain and the condition improves without surgery. Before the development of this disease, doctors prescribe symptomatic treatment.

Surgical treatment

To get rid of adhesions, as a rule, two methods of surgical intervention are used: open surgery and laparoscopy.

Open surgery is an operation that involves making a large incision in the abdominal wall. In this case, under the direct control of vision, the adhesions are disconnected using an electrocoagulator or a scalpel.
Laparoscopy is an operation in which a surgeon inserts a camera into the abdominal cavity through a small incision in the abdominal wall. After detecting adhesions, they are disconnected with scissors or cauterization with current.

Most often, they try not to use repeated surgical intervention, since this is characterized by the risk of new adhesions.

How to treat adhesions in the folk way?

There are many different folk methods that are used for adhesive disease. But in researching them safety and efficiency have not been studied, therefore, before using these methods, you need to consult a doctor.

Castor oil

Relieves inflammation and pain, and with continued use can reduce scar tissue. It is necessary to wet several layers of castor oil woolen or cotton fabric, place it on the stomach where it hurts. Wrap the fabric with cling film and fix it with something, tying the waist. Then apply a hot heating pad to this place. This heat allows the castor oil to penetrate the skin. It is necessary to keep this bandage for 2 hours, then remove it. It is necessary to do these compresses every other day.

Healing herbs

For treatment, it is advised to use calendula and comfrey, they can be used in combination with each other or separately.

Calendula and comfrey tea:

Two cups of water
0.5 teaspoon of calendula flowers;
0.5 teaspoon comfrey leaves.

Add herbs to boiled water. Let it brew for about 20 minutes and drain. If necessary, add honey. Consume every day.

Calendula and Comfrey Oil:

One cup of dried calendula flowers;
One cup of dried comfrey leaves
Olive and castor oil.

Put the herbs in the jar. Using the same ratio of castor and olive oils, add them to the herbs. To the bottom of the multicooker lay the fabric and place a jar of oil and herbs on it. Pour water into the multicooker bowl so that it barely reaches the top of the jar. Set it to keep warm and keep the jar for five days. You need to add a little water to the multicooker every day. After five days, drain the oil.

Gently rub this oil into your stomach twice a day. This should be done regularly for several weeks. We must not forget that before using any traditional medicine, you should consult your doctor.

Diet

Doctors failed to identify the connection between nutrition and the prevention or development of adhesive disease of internal organs. But patients with partial bowel obstruction will benefit from a slag-free diet.

This diet for adhesive disease limits the consumption of foods that contain large the amount of fiber and other substances, poorly absorbed by the digestive tract. While this daily menu is not well suited to the long-term needs of the patients, it can relieve abdominal pain and reduce stool volume during partial bowel obstruction.

During the adhesion process, brown rice, whole grains, juices with pulp, fruits and vegetables, and dried beans are removed from the diet. The patient can consume jellies, creamy soups, yogurt, ice cream, puddings, while they should not contain pulp and seeds.

Also, the doctor may allow the use of baked goods made from refined flour, refined white rice, crackers, low-fat broths and soups, cereals, fish, tender poultry. Also, a slag-free diet for adhesive disease can limit fermented milk products.

Prevention of the disease

Abdominal adhesions are difficult to prevent, but the risk of adhesions can be minimized.

Laparoscopic methods of performing surgical interventions reduce the risk of their formation, since they are performed through several small incisions. When is the execution minimally invasive surgery for some reason it is impossible, and a significant incision of the abdominal wall is required, then at the end of the operation, a solution or a special film can be used that reduces the risk of an adhesions.

Other methods that can be used during surgery to minimize the possibility of adhesions:

Careful touch to organs and tissues.
Use of gloves without talc and latex.
Using saline solution to moisturize organs and tissues.
Application of wet wipes and tampons.
Reducing the duration of surgery.

The appearance of an adhesive process after surgery on the abdominal organs is a fairly common occurrence. Most often this does not cause any symptoms and does not pose a threat to the patient's life. But in some cases adhesive disease may cause a vivid symptomatic picture of intestinal obstruction, which requires surgical intervention to eliminate.

Arthur 03/15/2018

Hello. Is there a high probability of adhesion formation after inguinal hernia surgery using the Liechtenstein method (mesh)? Can you say that in 95% of cases, adhesions appear? Thank you.

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Under the general name "adhesions" in gynecology, they mean adhesive disease - a pathological condition in which the formation of connective tissue cords is characteristic mainly in the small pelvis, as well as in other organs of the abdominal cavity.

The causes of the disease

The main causes of adhesions:

Previously transferred inflammatory infectious diseases of the reproductive organs.
Inflammatory non-infectious diseases of other organs of the peritoneum: appendicitis, colitis, duodenitis.
Delaying the treatment of inflammation and the transition of a neglected disease into a chronic stage.
Surgery and trauma. With mechanical damage, the formation of adhesions occurs due to hemorrhage of infected blood into the internal organs.
Foreign bodies in the abdominal cavity directly during surgical interventions.
The proliferation of connective tissue outside the endometrium is endometriosis.
Menstrual blood that has entered the abdominal cavity. If for some reason this blood is not removed, then adhesions form at this place.

Adhesions in the small pelvis disrupt the work and normal functioning of internal organs. In the intestine, the elasticity of its loops is disturbed, which leads to complete or partial obstruction. The adhesions that appear in the reproductive organs prevent the entry of the egg, the movement of the sperm and their connection in the fallopian tube. When conception has occurred, adhesions can become an obstacle to the advancement of the embryo into the uterus.

Complications of the adhesions - infertility, displacement of the uterus, intestinal obstruction, complete or partial, failure of the menstrual cycle, ectopic pregnancy.

The degree of manifestation of the adhesive process

Symptoms of the manifestation of adhesive disease are distinguished according to their severity.

Acute, severe degree. Pain syndrome progresses steadily, symptoms of general intoxication appear: weakness, nausea, vomiting, fever. On palpation of the lower abdomen, acute pain occurs. Immediate hospitalization is required. Along with the symptoms of intoxication, metabolic disorders, a drop in blood pressure are noted. The general condition of the patients is assessed as very difficult.
Intermediate degree, or degree of migratory pain. At this stage of adhesive disease, abdominal pain is periodic, wavy with a long painless interval. Patients often complain of intestinal discomfort, sudden diarrhea, or constipation.
Chronic, or latent, degree. The most common in the adhesive process. It is asymptomatic for many years. Occasionally worried about pain in the lower abdomen. The patient usually learns about adhesive disease by chance, while trying to recover from infertility.

If a woman cannot get pregnant for a long time, she is worried about pain in the lower abdomen, a violation of the chair, you should immediately seek help from a gynecologist.

The gynecologist notes the suspicion of the presence of adhesive disease during the routine examination of the patient on the chair. On palpation of the pelvic organs, their low mobility or complete lack of mobility is noted. The examination causes pain and discomfort. To clarify the diagnosis, the gynecologist takes the necessary crops and directs the patient for diagnostic tests.

Read also: The main causes of thrush in women

Diagnostics

Extended diagnosis of adhesive disease consists of the following examinations:

General clinical analysis of blood and urine.
Sowing for flora and sensitivity from the vagina, PCR diagnostics.
Ultrasound of the pelvic organs.
MRI of the pelvic organs (if ultrasound is not informative).
Laparoscopy. It is the most informative diagnostic method. The abdominal wall is incised in two places. In the first incision, the doctor inserts a laparoscope, in the second - a special manipulator, with the help of which you can touch the organ, move or move it. The camera, located at the end of the laparoscope, feeds what it sees to a special monitor. Thus, the doctor can reliably assess the situation and make the correct diagnosis.
Hysterosalpingography is a study using an X-ray machine and a contrast agent of the uterine cavity and ovaries. Allows you to determine the presence of adhesions in the uterus and ovaries.

Treatment and prevention

When treating infertility, it is important to determine the stage of the adhesion process:

In the first stage, adhesions are not an obstacle to the egg, since they are located next to the fallopian tube and ovaries.
In the second stage - adhesions on the ovaries, uterus and between them. At this stage, they interfere with the capture of the egg.
At the third stage, adhesions completely clog the fallopian tube, conception with such an adhesive process becomes impossible.

At the second and third stages, the most effective is surgical surgical treatment in combination with conservative. Laparoscopy is often combined with surgery to remove adhesions. If adhesions are found, the surgeon can remove them immediately. There are several methods for removing adhesions: laser removal, water removal (aquadissection) and removal with an electric knife. What method to use is decided by the surgeon depending on the type of adhesions detected. During the operation, in order to prevent the recurrence of adhesive disease, the surgeon introduces protective barrier fluids (Povidine, dextran) and applies a special protective self-absorbing film to the uterus and ovaries.

What happens to our body during operations? First, the tissues are cut, then they are connected, and they are forced to grow together again. It is believed that a laparoscopic operation, which is performed through several small incisions ("punctures"), is much less traumatic, since the surface of the operating field is much smaller than in a conventional "open" strip operation.

During laparoscopy, lesions are formed on the thin membrane covering the inner surface of the abdominal wall at the places where instruments are passed, incisions or clips. After removing the instrument, this section of the damaged membrane (it is called serous) heals on its own.

How adhesions and scars form

However, our tissues have one natural non-canceling property - they seek to protect our body. And sometimes the development of so-called protective factors after damage occurs intensively - with a margin.

What is Treatment for Adhesions after Surgery?

In practice, it looks like this: in places of damage to the serous membrane, collagen and elastic fibers and cells of connective tissue are intensively produced. If at this time any internal organ (for example, a loop of the intestine) touches the area of \u200b\u200bthe damaged serosa, it is involuntarily involved in this process. A cord of connective tissue is formed, which leads from the wall of the internal organs to the inner surface of the abdominal wall. This is called a spike.

Adhesions can also connect internal organs to each other. Each of them is also covered by a serous membrane. During the operation, her micro-tears are not excluded. And these places of microtrauma can also subsequently become a source of the formation of adhesions between this organ and the organs adjacent to it.

Also, at the site of contact and healing of tissues after their dissection or rupture, a scar can form, in which ordinary tissue is replaced by a more rigid and inelastic connective tissue. Scars can be on the skin, or on internal organs.

Why are spikes so bad?

Nature has taken care that in our harmonious body the organs are complete and arranged clearly and correctly, as in Tetris. They occupy the entire interior space and touch each other with suitable sides, like a carefully fitted puzzle. If we consider all the organs separately from the body, one can be amazed at how much space they take up and how they fit inside us! Precisely because postoperative scars and adhesions violate this initial harmony, they affect our body.

What is the negative effect of adhesions. They:

violate the mobility of the organ, which affects its function. Moreover, both external, dependent on the movements of the diaphragm, suffer, and internal - active and not dependent on the movement of the diaphragm;
disrupt blood circulation in the affected organ;
violate the innervation of the organ;
contribute to the occurrence of painful sensations and spasms in the organ.

Sometimes the adhesion is so powerful that it can disrupt the anatomically correct position of the organ. All of these reasons lead to other disorders in the body. Moreover, those that, at first glance, are not associated with the affected area. Adhesions and scars that have arisen after operations on the abdominal cavity can "give off" pain in various parts of the spine, joints, lead to a change in posture and a violation of body position in space, etc.

How are adhesions treated

By the timing of the formation of adhesions are distinguished:

7-14 days after surgery - the phase of young adhesions, when the adhesions are still very loose and easily break;
14-30 days after the operation - the phase of mature adhesions, when the adhesions thicken and become strong.

Starting from the 30th day after the operation and further, for several years, the process of restructuring and formation of scars and adhesions occurs. The process is individual, much depends on the properties of the organism itself, its anatomical structure, and the functioning of internal organs.

The doctor may suspect the presence of an adhesions in the abdominal cavity according to clinical data, anamnesis, and according to the results of such studies as ultrasound, CT, colonoscopy. The adhesion process in the abdominal cavity and the pelvic cavity can be treated with medication or surgery. During the operation, the adhesions are separated, but this method should be resorted to only in extreme cases, if the strands are so thick and rough that they greatly disrupt the function of the organ, and more loyal and gentle treatment does not help.

How osteopathy affects adhesions

The osteopathic doctor is able to feel with his hands where the adhesions are located and where they lead, where they are attached and what they are pinching. It is also able to loosen their tension in several sessions, can restore, balance and balance damaged organs, and therefore restore their function to the fullest extent possible.

It is also in the power of an osteopathic doctor to interrupt the chains of injuries and painful sensations in the parts of the body that seem to be unrelated to the operated area. After all, our body is an integral system where everything is interconnected. The osteopath acts on the adhesion directly, without violating the integrity of the body tissues, and therefore without an additional factor that stimulates the formation of connective tissue. By restoring and harmonizing the function of the affected organ, the body releases energy to initiate full recovery in possible individual conditions for the whole organism.

Any surgical intervention, no matter how minimal it may be, leaves behind many negative changes, trauma and stress, which the body has to fight alone. What the body will undertake for its healing, what it will sacrifice, how it will limit itself is always individual. But within the framework of self-preservation, this is always expressed in the loss of function to one degree or another, and therefore in the subsequent suffering of the whole organism with the loss of compensation and the expenditure of much greater forces on normal functioning throughout life.

Therefore, if in your life you have had surgical interventions on the abdominal organs, consult an osteopathic doctor. It does not matter whether the operation was conventional or performed with a gentle laparoscopic method. Any discomfort has a reason, which means there is an opportunity to solve it.

An osteopathic doctor can use pulse diagnostics to determine the significance of adhesions or scar on the body. This means that if, when you press on the postoperative scar, the properties of your pulse change, then this zone is important and significant for the whole organism, and you need to work with this adhesion or scar.

Adhesions and scars have the following significance and prevalence of influence:

local (the effect is limited to the area of \u200b\u200bthe scar or adhesion);
regional (the effect extends to the entire thoracic or abdominal region, where the adhesion is located);
global (affects the entire organism, up to the violation of its position in space).

How long does osteopathic treatment last?

If the patient has undergone surgery, then tactically, the osteopathic doctor will act as follows. 10 days after the operation, when the stitches are removed, the doctor will work in layers with the scar itself, work with the tissues directly around the scar itself and restore that independent mobility of the organ, which does not depend on the movement of the diaphragm. This period of work fits into terms from 10 days to 3 months after the operation.

If the duration after the operation is 3 months or more, then the doctor will pay attention to all the surrounding organs and tissues in the operation area, influence the mobility of all internal organs in general and directly on the localization of the adhesions themselves.

The information was prepared by the leading specialist of the Osteo Poly Clinic, an osteopathic doctor, a chiropractor, an endoscopic surgeon.

Postoperative adhesions are dense connective tissue formations in the abdominal or pelvic cavity that connect the internal organs. They are formed at the site of damage, inflammation and represent a kind of protective reaction of the body - an attempt to limit the focus of the disease. Adhesions disrupt the normal functioning of the abdominal organs and lead to serious complications.

Why are adhesions formed?

Connective tissue cords (adhesions) in the abdominal or pelvic cavity are formed as a consequence of surgical interventions or as a response to inflammatory processes in this area. The body builds up additional tissue, secretes sticky fibrin, and glues adjacent surfaces to each other in an attempt to support a diseased organ or stop the spread of inflammation. Adhesions can be in the form of scars, threads or films that connect adjacent organs and intestinal loops.

Reasons for the formation of adhesive strands:

tissue damage as a result of surgical interventions (laparoscopy, laparotomy);
inflammation of the appendix and surgery to remove it (appendectomy), diverticulitis;
abortion, uterine curettage, cesarean section;
long-term use of intrauterine contraceptives;
hemorrhage into the body cavity;
endometriosis;
inflammatory diseases of the abdominal and pelvic cavities, including venereal.

Postoperative adhesive disease is caused by tissue damage, hypoxia, ischemia or drying, as well as the ingress of foreign objects, some chemicals (talcum powder, gauze fibers) into the body cavity.

Why are adhesions dangerous?

Normally, the organs of the abdominal cavity and the pelvic cavity are mobile. Intestinal loops can shift during digestion, but their movements do not interfere with the transport of an ovulated egg into the fallopian tube, and the uterus that enlarges during pregnancy does not have a critical effect on the bladder.

The resulting scars, limiting inflammation, interfere with the normal mobility of organs and the performance of their functions. Adhesions can provoke acute intestinal obstruction or the development of female infertility. In some cases, the formation of adhesions does not cause discomfort to a person and unpleasant sensations, however, most often, adhesive disease is accompanied by severe pain syndrome.

Symptoms of pathology

The manifestation of the disease depends on the degree of its development. There may be individual adhesive cords fixed at two points, or a large number of adhesions over the entire surface of the peritoneal membrane.

Acute form

Pathology often manifests itself in an acute form, with sudden onset of pronounced symptoms, such as:

As the intestinal obstruction increases, the symptoms worsen:

bloating is observed;
peristalsis stops;
decreased urine output;
arterial hypotension occurs;
there is a violation of the exchange of fluid and trace elements;
the general condition worsens, weakness appears, weakening of reflexes;
severe intoxication occurs.

Intermittent form

Symptoms are less pronounced, appear periodically:

pain of varying intensity;
digestive disorders, constipation, diarrhea.

Chronic form

The adhesion process in a chronic form proceeds latently, can manifest itself as rare pulling pains in the lower abdomen, digestive disorders, and causeless weight loss. Often, adhesions are the hidden cause of female infertility.

Diagnosis of adhesive disease

It is possible to assume the presence of adhesions if the patient in the past has undergone surgical interventions on the organs of the abdominal cavity or small pelvis, infectious and inflammatory diseases of the genitourinary system, endometriosis.

These risk factors contribute to the formation of adhesions, but they are not a 100% guarantee of their presence. To confirm the diagnosis, it is necessary to conduct a series of studies.

Certain diagnostic data are given by examination in the gynecological chair.
X-ray examination of the uterus with the introduction of a contrast agent determines the obstruction of the fallopian tubes, the cause of which is often adhesions. However, if the patency of the oviducts is established, adhesions cannot be ruled out.
Ultrasound results cannot determine the presence of adhesions in the abdominal cavity.
Magnetic resonance imaging provides high accuracy of results.

The main method for diagnosing adhesive disease remains laparoscopy. With the help of special instruments introduced into the abdominal cavity of the patient during laparoscopy, the doctor can assess the degree of development of the pathology and, if necessary, immediately perform medical manipulations.

Treatment of postoperative adhesions

If the adhesions are just beginning to form at the site of the inflammatory process, there is a possibility of their spontaneous resorption, provided that they are promptly and adequately treated. Over time, the thin films of adhesions become coarse, thicken and look more like scars and scars.

Operation

The main method of treatment for acute and advanced chronic forms of the disease is the surgical removal of adhesions. The patient is given general anesthesia, and the surgeon uses special instruments to locate, dissect and remove adhesions.

To access the abdominal cavity, laparotomy (abdominal incision) and laparoscopic methods (access through punctures) can be used.
Excision of adhesions is carried out using a laser, an electric knife or water, which is supplied under strong pressure (aquadissection).

The operation provides a one-time removal of pathological formations, but does not guarantee protection against recurrence. The more the body undergoes surgical interventions, the more likely the development of the adhesive process. Therefore, special methods are often used to prevent pathologies after a medical operation: the introduction of barrier fluids (mineral oil, dextran), enveloping the organs with a self-absorbing film.

Enzymes

Enzyme therapy can have a good effect, including injections of cleaving enzymes (lipase, ribonuclease, lidase, streptase) and rubbing anti-inflammatory ointments into the abdomen.

One of the most powerful enzyme agents is human saliva. The substances contained in it are capable of dissolving adhesion tissue. Saliva is especially active in the morning, while a person has not yet eaten or drank. It is recommended to apply it liberally on scars.

Massotherapy

On manual examination of the abdomen, adhesions are found as compacted areas. Sometimes the pressure on them causes a pulling pain. The massage is designed to create tension in the affected area, activate the abdominal tissues, increase blood circulation, and separate the organs connected by adhesions.

You need to massage gently, with your fingertips, along the natural location of the internal organs. Do not massage immediately after surgery while the stitches have not yet healed.

Prevention of postoperative adhesions

The main means of preventing the formation of adhesions after surgery is, oddly enough, physical activity. The patient should get out of bed and walk the very next day after the operation. Any, even slow, movement contributes to the natural massage of the internal organs, which prevents the formation of scars and sticking films.

As early as possible (taking into account the patient's condition), it is necessary to start therapeutic exercises for the abdomen: moderate inclinations, body turns.

The combination of physical activity and special massage can prevent postoperative adhesive disease.