home Rectal cancer After surgery for female adhesions. What are adhesions in gynecology and what is their treatment. Learn more on this topic

After surgery for female adhesions. What are adhesions in gynecology and what is their treatment. Learn more on this topic

Hello my friends! Today's material refers to important issues of postoperative rehabilitation. We will talk about such phenomena as: contractures of the knee joint, postoperative adhesions and scars, about methods, measures and means of preventing this process, dangerous to health.

According to the assurances of the doctors and surgeons themselves, “A successful operation is only half of the success. The most important thing is correct rehabilitation. "Unfortunately, in most cases, not everyone and not immediately understand the importance and necessity of this statement.

And the need for rehabilitation is due to the fact that in its absence or the wrong approach to it, both minor and major troubles are possible. I will talk about rehabilitation after orthopedic operations, but the information and recommendations given below will be useful for other operations as well.

Some of these troubles are contracture of the knee or other joint and postoperative adhesions and scars. We will figure out what it is and why it is dangerous.

I'll start with a message that came to me from one reader. I have left only what is relevant to today's topic.

THANKS for the articles! … I have already gone through three operations on the knee joint. After the first operation (the anterior meniscus horn was removed), she recovered herself. After the second (the posterior horn of the same meniscus was removed), a plasmogel was placed (on the advice of the operating doctor). I went to the third operation (scars formed in the anterior torsion of the knee joint) ...

Unfortunately, the reader did not write anymore, and I do not know exactly her case, but the problem she faced is significant and familiar to very many. We will consider the process of the formation of so-called postoperative scars (adhesions) and clarify why, after orthopedic operations and others, the correct rehabilitation and the correct approach to this are very important. Let's start with the definition. What are adhesions?

Adhesions Is the tissue that grows between the organs and connects them. Adhesions occur during inflammatory processes, which can be a consequence of infectious diseases or surgical interventions. The body is simply trying to localize inflammation or repair damage. Thus, adhesions can also occur during operations on internal organs.

Adhesions can be of different shapes, can be penetrated by blood vessels and formed by different types of connective tissue. They contribute to the appearance of pain, joint blockages, muscle atrophy, restriction of movement, intra-articular effusion (accumulation of excess fluid), and soft tissue edema.

In the case of orthopedic operations, adhesions are also a natural process for the body to restore not only tissues damaged by trauma (ligaments, skin, tendons), but also to restore, first of all, the fibrous membrane of the articular capsule, which, during the manipulations of the surgeon, is damaged. In this case, the adhesions take the form of scars and are very similar to the scars we see on the skin. These are fibrous adhesions that occur during prolonged postoperative periods of immobility. (please pay attention to these words). Such connective scar tissue does not have the required elasticity and other necessary properties, begins to limit the work and mobility of the joint and other processes occurring in the joint capsule.

But the detrimental effect of the adhesive process is not limited only to this. The joint is quite complex and well thought out structure. As described in, the joint has volvulus and bursa filled with synovial intra-articular fluid. These turns are needed for a reason. They are arranged in a special way, and the joint fluid does not hang out in the joint as it should.

Twists and bursae form channels through which, with the help of mechanical movement and internal pressure, synovial fluid circulates inside the joint, washing the cartilage and carrying (taking) nutrients and waste products of cells. Adhesions and scars block these streams and channels, depriving the cartilage of nutrition, which leads to their rapid destruction. Another reason to take postoperative rehabilitation more seriously.

The more surgical intervention, the more postoperative adhesions and more restrictions in the work of the joint. If this process is allowed to take its course, the adhesions become rough, tough scars and can only be removed by a new surgical intervention, as the reader wrote about. That is, in order for the joint to bend and unbend again in its amplitude, and the intra-articular fluid to circulate correctly through the joint, a new operation has to be done to cut adhesions and scars.

The only way to prevent such troubles or to make them less pronounced is proper rehabilitation. Depending on the individual characteristics of the human body, adhesions may, with the right approach, either not form, or quickly dissolve. But for this you need to make some efforts, and these efforts are the correct process of rehabilitation, and as early as possible.

To prevent unwanted adhesions the very next day after operations on other organs (but here it is more difficult for me to say), and during orthopedic operations, it is necessary to start moving and do elementary exercises. This is proven by official medicine, and the importance of this is confirmed by the fact that immediately after the operation in the clinic, a doctor or a rehabilitation therapist on duty comes to the patient, giving and showing elementary physical movements for the operated limb.

If the operation was on the internal organs, then the movements are also necessary and cause a natural massage, which does not allow the formation of adhesions. In joint surgery, movement plays the same role. Joint movements do not allow adhesions to form, establish proper blood flow to the muscles and ligaments, and the healing process occurs faster.

What are knee contractures

The formation of adhesions is also facilitated by other processes in the joint and, above all, joint contractures.

Contracture - these are restrictions in the movement of the joint. The joint cannot bend or unbend completely, according to its usual amplitude.

This is an almost natural process that occurs after injuries, fractures and surgeries. Damaged tissues and nerves, due to inflammatory, cicatricial contraction of muscles, tendons, pain reflex, do not allow the joint to bend and unbend. Here we get a vicious circle: contracture, limiting movement, contributes to the formation of intra-articular scars and adhesions, and adhesions and subsequently scars lead to even greater contracture. Moreover, this process is quite fast, as well as the healing (restoration) of damaged tissues by the body. This moment must not be missed.

The emergence of an adhesion process is also possible with degenerative-dystrophic diseases of the joint, just a little more time is given here. The reasons for contractures are the same.

After my second operation on the knee joint, already at the first dressing, the surgeon told me to bend my leg to 90 ° in a week. So in bed, standing on crutches, and sitting, I was constantly bending and unbending my poor knee.

In this article I will not give sets of exercises, etc. I will describe the existing methods of dealing with the adhesive process. Everything is based on my experience and recommendations given to me personally or to other athletes I know. But I remind you that visiting a rehabilitation doctor at least a couple of times after the operation is a prerequisite. Then, already knowing exactly your condition, you can experiment yourself, develop or strengthen the set of exercises given by the doctor.

The most ideal is to undergo various and rehabilitation in a specialized center, as it is established in. Everything is different with us and completely different difficulties and problems of our life come to the fore. I understand. And I myself did almost everything myself and relied only on myself. But after each operation, I visited the rehabilitologist and followed the recommendations given to me.

In addition, it must be borne in mind that I do sports all the time. If I had small joint contractures, I knew that I could overcome it with my already sports training.

The most difficult thing is to overcome the first stage of postoperative recovery, because everyone will feel sorry for you, take care of you, serve you everything and rush around like a child. At this moment, it seems to you that you can do nothing and do not need to do anything yet. Like, let it all heal. I’ll lie down for a week or two on sick leave, and then I’ll go to a rehabilitologist. And this time is the most important, because right now, with active healing and restoration of the body, the adhesive process is most active.

Classes for working out the operated joint should begin immediately after the operation. Well, okay, right after your surgery you can get some sleep.

In addition, after anesthesia (it does not matter, general or local), you cannot get up, otherwise your head may hurt a lot. Remember this. Better to lie down for the rest of the day and not get up. Moreover, everyone tolerates anesthesia and anesthesia in different ways.

But from the next day, it is already necessary to do the exercises. This applies to operations on the knee, hip, and other joints; this also applies to arthroplasty (replacement with artificial) joints. In our state clinics, after the operation, a rehabilitologist immediately comes and shows what to do and how. Listen to him.

As for paid clinics, no one there, most likely, will not do or advise anything superfluous. Therefore, the recommendations of the article are required. And as soon as you get up on your feet (even on crutches), immediately after the first examination by a surgeon, you need to go for a consultation with a rehabilitation therapist. Until this moment, it is necessary to do simple exercises several times a day (3-4 times) and follow the recommendations:

Pedal - foot movements from oneself to oneself (10-20 times in 3 sets).
Alternating tension and relaxation of the muscles of the operated limb (10-20 times, 3 approaches with a delay of 5 seconds)
Bending the knee lying down, to pain as it turns out (10 times in 3 sets).
Bending the knee while sitting with the healthy leg to pain as it turns out (10 times in 3 sets).
Raising a straight leg while lying. After the operation, it is difficult and painful, but you have to try. In the half-sitting position, lean on your elbows, the healthy leg is bent at the knee, the operated leg is raised (10 times in 3 sets)
Apply ice constantly to the operated joint (20 minutes every half hour or hour).
Do not forget to follow other recommendations and prescriptions of the surgeon given at discharge.

Anti-adhesion agents

Enzyme therapy

The first means of preventing adhesions is the so-called enzymatic therapy. Naturally, it can only be used after the incisions have healed and the stitches removed. In orthopedics, ointments that contain enzymes are prescribed. During intra-abdominal operations, injections with enzymes are also given.

Enzymes or enzymes - these are protein molecules that are catalysts for various processes in the body and affect the rate of these processes. Food enzymes or digestive enzymes speed up the digestion processes, or in our case, enzymes contribute to faster healing and destruction of damaged tissues by the body, resorption of blood clots and bruises, thus helping in the treatment of purulent and inflammatory processes. Even in the treatment of cancer, enzyme therapy plays an essential role.

Enzymes are produced by living cells, but their peculiarity is that they are able to maintain their unique properties outside the cells. This allows the person to administer enzyme therapy and, if necessary, use enzymes. This way we can buy ourselves enzyme products for additional use.

The recommendations given below for enzyme therapy are not recommended to be carried out on their own in case of problems with the gastrointestinal tract, digestive problems, diseases of the pancreas, without consulting your doctor. This method is based on the recommendations of doctors, but may not be suitable for everyone. Be careful.

Enzymes work in our body to digest food. Enzymes taken with food help and speed up the digestion process, improve it. If enzymes are taken on an empty stomach, then their action will be directed precisely at combating inflammation and damaged bad cells. Adhesions and inflammation in the joints, in which adhesions begin to form and bodies that destroy the joints begin to form, in our case, are the goal of enzyme therapy. The enzyme preparation should be placed under the tongue and gradually dissolve. Thus, the enzymes will enter the bloodstream and other systems of the body faster. The timing and dosage of such treatment are determined by the manufacturer and according to the instructions for use, or by the attending physician. This cannot be abused.

Completely natural and delicious complex of enzymes (enzymes) from papaya for resorption Natural Factors, Chewable Papaya Enzymes, 120 Tablets... A quality product at an affordable price.

Another very famous drug with enzymes, intended for the treatment of joint and muscle pain, Wobenzym N. It contains only natural enzymes and has a powerful anti-inflammatory effect on the body. Before buying, carefully read the manufacturer's description and recommendations, reviews of other people.

Wobenzym, Wobenzym N, Healthy Joints, 200 Tablets.

Taking enzymes with food with food will simply promote better digestion. This method is prescribed for diseases of the pancreas and other organs of the digestive system, but we must remember that

constant use of enzymes is undesirable. The pancreas is an organ that produces enzymes in our body and monitors their need and quantity. If you take enzymes constantly, then the pancreas can stop working and disable its functions. Be careful! To a greater extent, this applies to animal enzymes, but taking plant enzymes, you should not do it without control.

Enzyme ointments against scars and adhesions

The following products are ointments and preparations containing enzymes and other active substances. For example, I will give the name of the drugs that the doctor prescribed to me specifically for the resorption of intraarticular scars and adhesions. Naturally, this was in the initial stages of rehabilitation, more to prevent this process in its initial stages.

Ointment Zel-T is a homeopathic chondroprotective drug with a broad spectrum of action: protective, anti-inflammatory, chondroprotective and analgesic. Contains a large amount of active herbal and natural ingredients. The active herbal substances of the drug help to reduce swelling, pain, improve joint mobility, and have other beneficial effects on cartilage, bone and soft tissues. Recommended to prevent postoperative adhesions and scars. Doctors of various disciplines very often prescribe Goal-T drugs to patients. This drug is popular in Germany and other European countries among athletes and ordinary people with various joint diseases.

You can supplement the effect of the ointment on the body with Zel-T tablets with similar actions. The pills just need to dissolve.

Another good homeopathic remedy with natural herbal ingredients is Traumeel S. These medications are well studied and have been tested and researched, using the most stringent standards, their effectiveness has been proven. Good for. The drug has been proven to be highly effective on athletes and ordinary people with various injuries and diseases of the joints and ligaments.

Homeopathic ointment Traumeel S.

Homeopathic lozenges Traumeel S.

Ointment and cream Karipain. The ointment is used to treat joint contractures (post-traumatic and post-stroke), colloidal scars of various origins, etc. It is a direct-acting enzyme preparation. Contains enzymes from papaya. The doctors probably like it too. I was prescribed it and I used it for some time.

I can not but advise my beloved and providing a huge variety of tools for any problems, the IHerb online store. What can we say, there you can buy very high-quality and effective products and often much cheaper than in our pharmacies.

Painkillers and medicinal ointments and remedies MediNatura .

T-Relief, Arnica + 12 Natural Ingredients, Ointment (50 g) and Pain Relief Tablets (100 tablets)... A set of tools to try the effect and tolerance of drugs. Later you can order separately. Read the information on the website carefully.

Pain reliever and all-natural homeopathic remedy for arthritis, joint pain and stiffness T-Relief Arthritis.

Based on natural herbal ingredients, Zel-T, Traumeel S and T-Relief can be taken independently without a doctor's prescription. But if possible, then before use and purchase, consult your doctor.

Postoperative rehabilitation products

And now we proceed to the most important point. Lazy ways to prevent adhesions are over. It is necessary to work here already. So, the rehabilitation process. In this article, I will not describe exercises and classes, rehabilitation programs. This is a topic for separate articles. Here, I will just remind you once again about the importance of this process in restoring the body and returning to its original healthy and full-fledged state.

The surgeon or orthopedic surgeon should tell you the importance of the rehabilitation process. In the future, the rehabilitation doctor, based on your condition and capabilities, draws up a program and corrects it every month. It is very important. The main goal of rehabilitation is to prevent undesirable consequences of operations in the form of adhesions, scars, contractures and to return the operated injured limb and muscles to the maximum possible healthy state. During the rehabilitation process, at various stages of its passage, in addition to willpower and the desire to heal and get on their feet, various devices are needed. Unfortunately, you can't do without them. They are also prescribed by a doctor and there is no getting around here.

Knee pads and orthoses

These are various knee pads and orthoses that support the joint and muscles. Orthoses and knee pads can be of various designs and purposes, depending on the injury or the operation performed. They can also help you avoid the psychological anxiety that comes after a serious injury. They, too, should be advised and selected by a doctor.

Rehabilitation devices

Even in the hospital, after knee surgery, special developing machines and apparatus can be used. For example, such a mechanotherapy apparatus is used for passive development of the knee and hip joints immediately after surgery. You lie, and the apparatus itself bends and unbends the leg in accordance with the set parameters.

To be honest, I have not tried this. Probably, this is already completely for the lazy or in more difficult conditions, or for athletes and in clinics abroad. But this unit was not in vain invented and its use in the first weeks after the operation, when bending the knee brings a lot of strength and anguish, is very desirable, especially in elderly patients.

This includes such rehabilitation means as. The range of action of such devices is wide enough, they can be used for various conditions and diseases of the joints. The main purpose is to increase blood flow under the influence of magnetic fields, as a result of which the nutrition of damaged tissues is improved and the recovery processes are accelerated. I cannot say how effective these devices are and in what cases they help exactly. But in the clinics and hospitals where I operated, the nurses carried them to the wards and put such devices for us, the patients. From which we can conclude that they are recommended and used by official medicine in large state clinics. They put me like this. It has a pleasant, slightly warming effect.

I just want to warn you against buying such devices in unverified stores and for a price that does not correspond to reality. There are many scammers now, be vigilant and careful. Be sober about the possibilities of such therapy and the promises of the sellers.

This is a regular rubber sports band or a rubber band to increase the load when doing knee exercises. Can be used in other cases as well. If you have a desire to study, then it will not disappear in the future. You can buy such devices cheaply at all known Aliexpress .

Or weights that can be used on a stronger leg and exercise with them.

We must not forget about the most universal remedy - ice. In the early days, you will need an ice pack often enough to reduce swelling and pain. I had a lot of everything: from bags of frozen vegetables (by the way, very convenient) to special heating pads. You can just freeze a heating pad with water.

When enough time has passed after the operation, the postoperative stitches will be removed and healed, you can use various ointments (cooling and nourishing) or warming up, when the swelling and inflammation subside and this will be allowed at the next examination with your surgeon. This is the best time to use the drugs recommended above.

Such a special ball to restore the balance of the operated leg must be used to restore balance and train balance.

Briefly, if there was an operation on the anterior cruciate ligament, then the sense of balance was lost on this leg. This is due to the fact that the anterior cruciate ligament has another important function - it determines the position of the leg in space, i.e. is the organ through which our brain determines this very position. Such a ball and a stand on one leg will allow the brain to establish this connection through detours and compensatory mechanisms. This disc balance is a must after cruciate ligament surgery.

But these devices for exercising at home and replacing many simulators, allowing you to do many different exercises, will already make it possible to strengthen both the operated limb and other parts of the body. These home trainers can be used both for performing the obligatory simple exercises at home during recovery, and later, already developing muscle strength. If you do not have the opportunity to go to the gym later or do not want to, then such devices will help a lot, will be useful just for the mandatory physical exercise of every person leading a healthy lifestyle.

Most importantly, remember that all this will help you only if it is used, and not lying around at home just like that, reminding you of wasted money, and your willpower and desire for complete recovery will be connected.

All of the above must be done. Unfortunately, statistics indicate a large number of contractures, complications and reoperations due to adhesions and improper rehabilitation.

It seems to me and I hope you will agree that it is much easier to endure and overpower yourself, to make you work for a couple of months, than to undergo repeated operations, new monetary, moral and other expenses again. And if you knew how painful it is sometimes. I'm not scaring, but I hope you understand me.

All the best. Do not be ill!

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Laparoscopy is considered to be a low-traumatic surgical procedure, which is performed for various indications. Complications after it occur extremely rarely, and the recovery period does not last long. But can adhesions form after laparoscopy? This operation is the safest way to treat gynecological diseases. It is often used to eliminate adhesions, but it can itself be the cause of their formation.

- These are seals of connective tissue that connect the internal organs to each other. This is contrary to human anatomy. Adhesions after laparoscopic surgery appear as clear or whitish stripes.They lead to deviations in the functioning of the body. That is why the adhesion process is a pathological phenomenon and needs treatment.

Adhesions after laparoscopy of the ovary are rare, but extremely darken the life of a woman. They do not always make themselves felt, but sometimes they lead to the development of complications. In addition, the cause of the pathology can be inflammatory processes in the pelvic area. It is noteworthy that adhesions are formed at almost any age.

Factors contributing to the development of adhesions after laparoscopy:

diabetes;
damage to the sheets of the peritoneum or their "overdrying" due to the filling of the abdominal cavity with carbon dioxide at an unsuitable temperature;
moving bacteria to the surgical site from other parts of the body (this prevents normal tissue repair);
advanced age;
burn injury to tissues with a radio wave knife, plasma scalpel or other device during the coagulation process;
use that takes too long to dissolve;
oxygen starvation of tissues and improper metabolism in them;
leaving cotton balls, suture material, etc., in the area of \u200b\u200bmanipulation;
development of the postoperative infectious process (rarely happens).

Symptoms of adhesions in the small pelvis

Signs of an adhesive process may be absent. As the postoperative scar thickens, it is possible that pulling pains may appear in the operated area, intensifying with active movements, as well as pain during intimacy.

The following manifestations of pathology are possible:

development of intestinal obstruction;
improper functioning of internal organs;
pelvic pain (abdominal or chronic);
menstrual irregularities;
infertility;
the presence of uterine bleeding with an unpleasant odor, not due to menstruation.

What to do if adhesions develop after laparoscopy

Change in nutrition

In the presence of an adhesive process after the operation, the laparoscopic method shows a change in the diet, contributing to the speedy elimination of pathology. Spicy, fried and fatty foods are excluded from the diet, as well as:

foods that increase gas production in the intestines;
alcoholic drinks;
spicy and fatty sauces;
pickled and smoked dishes;
canned food.

The menu for adhesions should consist of fermented milk products, lean soups, low-fat meat and fish dishes, chicken eggs, fruits and vegetables, and various cereals. It is optimal to eat food in small portions from five to six times a day.

To avoid the development of the adhesive process, it is recommended to use an anti-adhesive gel, for example, Mesogel. It is rubbed into the skin with a thin layer. You can perform special exercises aimed at eliminating pathology. Learn more about anti-adhesion exercises HERE.

Adhesive process therapy

With an asymptomatic course of the pathology, conservative therapy is indicated, involving the use of drugs and the passage of physiotherapeutic procedures. If these methods are ineffective, then at the request of the patient, relaparoscopy is performed.

Chronic pain is usually treated conservatively, including by local exposure to the affected tissue. Physiotherapy and electrophoresis procedures are practiced with the use of absorbable agents (iodides and lidase). Drugs are prescribed to relieve pain and other symptoms of pathology.

The patient, who developed intestinal obstruction as a result of the adhesive process, is hospitalized in a hospital. Next, an analysis of the viability of the intestine is carried out and the question of the need with the capture of healthy tissue is resolved.

Laparoscopic adhesion removal

Dissection of adhesions is performed by laparoscopic access. In this case, three incisions are made on the woman's abdomen (no more than a few millimeters in size). In the process of manipulations, the normal ratio of the organs of the reproductive system is restored, adhesions are removed, and a new hole is formed in the fallopian tube instead of the sealed one.

Methods for removing adhesions:

laser therapy, in which adhesions are dissected with a laser after removal of the uterus and ovaries or other surgery;
aquadissection - problematic tissues are eliminated with water supplied under pressure;
electrosurgery, in which an electric knife is used to eliminate adhesions in the small pelvis.

Laparoscopy of the formed adhesions rarely leads to complications. After it, the patient is in the hospital for no more than two days. They let her go home on the third day and from that moment she is under the supervision of a gynecologist at the place of residence.

Prevention of adhesion formation after laparoscopy

To prevent adhesions after laparoscopic surgery, it is necessary to focus not only on drug treatment. The patient needs to move carefully after the operation, temporarily giving up active sports. Below are other measures to prevent the development of pathology.

Drug therapy, consisting of antibacterial and anti-inflammatory drugs, as well as anticoagulants and fibrinolytic agents, will help to avoid the formation of adhesions. The action of the latter is aimed at preventing the growth of fibrin - the main component of adhesions. Longidaza, Wobenzim, Ascorutin are often appointed. Collection No. 59 normalizes female reproductive function, eliminates the inflammatory process in the ovaries, and reduces the likelihood of adhesions formation.

Drug therapy lasts 2-4 weeks. As practice shows, in women who undergo it, the adhesive process develops less often than in those who neglect the doctor's prescriptions.

Another way to prevent pathology is the introduction of a barrier fluid into the abdominal cavity, which prevents the connection of tissues with fibrin threads. Due to the special solution, the organs cease to touch and "stick" to each other.

softening of connective tissue. As a result, it becomes more elastic, which reduces the severity of pain syndrome, contributes to the prevention and treatment of adhesions.
improving metabolism in tissues. Adhesions often lead to compression of organs, which is the cause of chronic constipation and menstrual irregularities. Physiotherapy normalizes metabolism and blood supply in tissues, stimulating the regeneration of the latter.

Massage therapy is usually used in conjunction with physiotherapy. It is contraindicated in some patients. The obstacles to its implementation are:

any oncological;
the presence of an infectious disease due to laparoscopy;
violations of the integrity of the skin in the pelvic area or abdominal cavity.

Moderate physical activity and special exercises will help prevent the appearance of adhesions. Before proceeding with them, you need to consult your doctor.

To avoid adhesions, you need to adhere to a certain diet. In addition, the penetration of infection into the seam should not be allowed, and it is also forbidden to play sports for some time. A correct lifestyle significantly reduces the likelihood of developing pathology.

It is advisable that a specialist explain to the patient all the measures for the prevention of adhesions. It is important to do this before hysterectomy or any other surgery. A woman is unlikely to have to undergo repeated laparoscopy of the appendages if she is attentive to her health, avoiding strenuous physical exertion and following all the doctor's instructions in the postoperative period.

Adhesions are connective tissue that grows in the abdominal and pelvic cavity. It connects organs and other structures to each other. Adhesions after surgery to remove the uterus appear quite often. Medical statistics show that they occur in 90% of cases. This condition is a complication that is dangerous for a woman's health.

Collapse

Adhesions concept

Adhesions are additional tissue characterized by sticky fibrin secreted by it. Because of this, this tissue glues the organs together. This is due to the protective reaction of the body, that is, the growth of adhesions is necessary to maintain the diseased organ or tissues affected by the inflammatory process.

Connective tissue can look different. Namely, in the form of a film, scar, threads. These forms of tissue appear after strip surgery or after minimally invasive interventions.

Reasons for the formation of adhesions after removal of the uterus

The formation of adhesions after removal of the uterus is a frequent occurrence, since the healing process is accompanied by the formation of a connective scar. The space that has formed begins to overgrow. The main reason for the appearance of the adhesive process is an individual feature of the body, in which it does not produce an enzyme responsible for the resorption of fibrin deposits.

The causal factors of this pathological condition are:

Additional trauma to adjacent anatomical structures.
If during a surgical operation the doctor left instruments, napkins, tampons, etc. in the abdominal cavity.
Infection during the operation, that is, the use of improperly processed instruments, or irregularities during dressings in the postoperative period.
The occurrence of such a complication after surgery as internal bleeding.
Activation of the inflammatory process.

In addition, the formation of adhesions is influenced by the incision during the operation, namely, the correctness of its implementation. The duration of the operation itself is also important.

Note! Medical practice shows that strains after removal of the uterus appear in women who are too thin.

How long does it take to form adhesions?

Adhesions begin to form from an accumulation of inflammatory fluid or blood that did not dissolve after surgery. Moreover, their formation begins already from 7-21 days. The exudate gradually thickens until this time and begins to be replaced by connective tissue. After 30 days, blood capillaries and nerve fibers are formed in it.

Symptoms and signs

In most cases, the presence of adhesions does not appear in any way. Symptoms appear when the situation becomes more complicated.

The main symptoms are intestinal dysfunction. Namely, intestinal obstruction, which is manifested by a pathologically rare defecation or a complete cessation of stool discharge. Constipation and flatulence are also observed.

Additionally, there will be such symptoms:

general malaise and hypotension;
pain in the lower abdomen;
in the future, the patient's condition is complicated by frequent bouts of nausea and vomiting;
soreness of the postoperative suture;
the postoperative suture becomes inflamed - it melts bright red, edematous;
sometimes there is a fever;
pain after intercourse.

Diagnostics

Diagnosis of the adhesions is difficult, since the setting of an exact verdict is possible only after laparoscopy or a full-fledged abdominal operation. But the doctor can suspect the presence of adhesions after such diagnostic methods:

Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
Ultrasound of the abdomen and pelvis allows you to assess the location of the organs. The doctor may assume that there is a lesion with connective tissue, since the organs will be incorrectly located.
Diagnostic laparoscopy is a minimally invasive method that allows you to fully visualize organs and other structures using a special manipulator.

When adhesions form after surgery to remove the uterus, an X-ray examination of the intestine is sometimes prescribed, especially if there is a complex of symptoms of organ dysfunction. In this case, contrast agents are used. As a result, it is clear how narrowed the intestinal lumen and what degree of intestinal patency.

Danger of adhesions

The adhesions themselves are a postoperative complication. They can cause serious consequences, since the proliferation of connective tissue contributes to the disruption of the normal functioning of organs.

Dangerous complications are:

intestinal obstruction of acute form;
necrotic intestinal lesion;
peritonitis.

Treatment

When a woman's uterus is removed, she is prescribed preventive therapy. It includes a list of medications that also prevent the formation of adhesions. These include anti-inflammatories, antibiotics, and enzyme medications,

Physiotherapy has also proven its effectiveness. They are used both for the prevention of the manifestation of adhesions, and already in their presence.

Physiotherapy

Electrophoresis is one of the physiotherapy procedures that can destroy postoperative adhesions. And also has a pronounced effect, that is, the symptoms are removed. Usually 10-12 procedures are prescribed. Electrophoresis is used in conjunction with pain medications.

In addition, paraffin and ozokerite applications are used. Today, laser therapy and magnetotherapy are popular methods of treatment.

Enzyme preparations

Fibrinolytic agents are very effective in the presence of adhesions, since they contain enzymes that can dissolve fibrin. These include:

Urokinase - breaks down blood clots by dissolving them.
Fibrinolysis - this substance is capable of dissolving fibrin.
Chemotrypsin is an agent that helps to thin the viscous exudate and thickened blood. The active substance breaks down fibrous deposits and necrotic tissue.
Hyaluronidase (Lidase) - this drug contains hyaluronic acid in its composition. The action is aimed at softening scars, as well as for the treatment of hematomas.
Streptokinase - this agent is able to dissolve blood clots, or rather dissolve fibrin in blood clots.
Trypsin.

Laparoscopy

Laparoscopy is a minimally invasive surgical treatment. This method consists in making several small incisions by the doctor through which the instruments and manipulator are inserted. During the operation, the adhesions are dissected and the vessels are cauterized. Also, the doctor must remove the synechiae. This is done using a laser, aquadissection, or electrosurgery.

The positive factor of such treatment is the minimal list of complications, which, moreover, are extremely rare. Also, rehabilitation after laparoscopy does not last long. The very next day after this operation, a woman can get up. The recovery period is no longer than a few days.

A strip surgery to remove adhesions is called a laparotomy.

Prevention

The main prevention of adhesions is the correct surgical treatment, without any disturbances, since adhesions are formed after operations. Also, improper rehabilitation methods can affect the manifestation of strands. How to avoid adhesions? Doctors recommend after the intervention to remove the uterus:

Follow a diet.
Correctly care for the postoperative suture so that there is no infectious infection of the wound.
Avoid excessive physical exertion, but you need to move more.

If all these rules are followed, then the risk of adhesions is reduced.

Conclusion

The adhesion process after the operation is quite dangerous. Therefore, if you experience any symptoms, you should consult a doctor. After all, this pathological condition can lead to dangerous consequences.

Among many people who have undergone operations on the abdominal organs, there is a misconception that after this, adhesions are necessarily formed, due to which they experience discomfort and pain. Allegedly, this is inevitable and you need to accept it. Unfortunately, some healthcare professionals also think so.

However, more than thirty years of practice of monitoring and treating such patients allows us to look at this problem more optimistically. There are the simplest ways that are available to everyone and help to avoid possible complications.

What are adhesions? This is additional tissue in the interorgan spaces of the abdomen (in the form of bizarre films, cords, threads), which was formed as a result of inflammation. Adhesions limit the elasticity and mobility of internal organs, make it difficult for food to move through the intestinal lumen. Sometimes they can even cause acute intestinal obstruction. In milder cases of the disease, adhesions periodically or constantly cause discomfort, bloating occurs, cramping or aching pains appear. In such patients, there is an intolerance to rough, poorly digested food, a tendency to constipation, decreased ability to work, and fatigue.

But the formation of adhesions in the abdomen does not depend on the actions of the surgeons. This is a biologically natural reaction of the body, aimed in essence at delimiting the zone of inflammation in the abdomen. As the inflammation subsides, adhesions dissolve without a trace within 3-6 months. However, in some cases, under the influence of adverse factors and characteristics of inflammation, they still remain and their development continues. They become rough, dense, very similar to scars at the sites of mechanical damage to the skin of our hands and feet. How to avoid adhesive disease? After surgery on the abdominal organs, on the second day, if the general condition permits, you need to start turning in bed and preferably be on one side or the other for at least a few minutes, and periodically take deep breaths and exhalations. And as soon as the wounds on the abdomen heal - this is about 8-12 days after the operation - you should begin to perform light bends and turns of the torso. The more often the patient displaces the internal organs in this way, the more it will prevent them from sticking together and sticking together. A few words about nutrition. After the operation, some food restrictions are needed. You should eat easily digestible food in liquid and semi-liquid form, drink natural juices, take multivitamins with microelements. Frequent and fractional meals are advisable: 6-8 times throughout the day in small portions. This stimulates the movement (peristalsis) of the intestine. What advice can you give to those who have been suffering from adhesive disease for many years? It is possible to accelerate the resorption of adhesions by complex treatment using enzyme therapy. For this purpose, the polyclinic uses injections of lidase, lyrase and other drugs with the ending ... aza: streptase, urokinase, ribonuclease. Useful rubbing into the abdominal wall of ointments, gels, balms, creams containing anti-inflammatory, analgesic substances and plant enzymes. At the same time, organ massage is performed at the same time.

Valery Ivanovich OSIPOV, Professor of the Department of Faculty Surgery of the Chita Academy of Sciences,
HLS magazine, 4/58 2008

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COMMENTARY

Wiktor Sergeew / 2019-06-30

Hello, can you tell me why, after the operation for intestinal obstruction, he himself lost a lot of weight, but the stomach seemed to be swollen.

However, despite all efforts, often after extensive surgical interventions, the adhesion process continues to develop. This is largely determined by the characteristics of the human body and the nature of the intervention. However, even after adhesions appear, the intestines can be treated by reducing the symptoms of the disease.

Causes of occurrence

Adhesive disease is a condition that occurs when a large number of individual adhesions are formed or a significantly pronounced adhesive process forms, which leads to disruption of the functioning of internal organs.

In most cases, intestinal adhesions occur after surgery. Most often they appear after major operations performed by laparotomy (through a large incision in the abdominal wall).

Doctors who operated at the dawn of surgery noticed that, if repeated operations were necessary, adhesions between separate organs were found in the abdominal cavity. Even then, it was clear to the surgeons that the numerous complaints that patients present after surgical interventions on the abdominal organs are associated with adhesions. Since then, a complex history of studying this problem began.

The adhesion process is currently one of the most studied pathological processes in the human body. The main reactions of the internal environment that play a decisive role in the emergence of adhesions include:

inflammatory tissue response;
coagulation of blood and proteins contained in it;
anti-clotting.

During surgery, trauma to the peritoneum is inevitable. In the event that only one of her leaves was damaged, and the one with which she is in contact remains intact, the adhesion does not form. But even if such an injury caused the appearance of fusion between organs, then it will be superficial, easily exfoliated and will not lead to a violation of the function of the organs.

If 2 touching sheets were injured, then a whole cascade of pathological reactions starts. Due to the violation of the integrity of the blood capillaries, the release of individual blood proteins occurs. Globulins (namely, coagulation factors) play the main role in the adhesion of organs. When these proteins come into contact with the exposed intestinal tissue, a cascade of coagulation reactions is triggered. The outcome of this cascade is the precipitation of fibrinogen in the form of fibrin. This substance is a universal "glue" of our body, which leads to the formation of early intestinal adhesions.

In the process of blood coagulation, the anticoagulant system plays a significant role, which is activated somewhat later by the coagulation system. In most cases, the blood that gets on the peritoneum of the intestinal loops first coagulates, and then goes back into the liquid phase precisely due to the fibrinolysis system (dissolution of precipitated fibrin). But sometimes, upon contact with the peritoneum, this process can be disrupted, and the fibrin does not dissolve. In this case, whites may appear.

How does the disease manifest

In most cases, the formed adhesions are small and do not actually affect the functioning of internal organs. However, when the structure is deformed, adhesion symptoms occur. The clinic depends on both the size and the localization of the pathological process. The most common symptoms of adhesions include:

abdominal pain;
feeling of discomfort in the abdomen;
constipation;
general weakness;
mental disorders.

Pain in the abdomen is the main manifestation of adhesive disease. The cause of the pain is a severe bowel dysfunction. The nature of the pain may also differ from patient to patient. In some, it is permanent, in others it is cramping. A feature of pain receptors in the intestinal wall is their increased sensitivity to stretching. Therefore, physiological bowel movements (peristalsis) can lead to significant bowel tension and provoke pain.

This is also the cause of pain after eating a certain food, which contributes to increased gas production or increased peristaltic movements of the intestine. Separately, it is worth mentioning the pain that increases with physical exertion.

Most often it occurs when the adhesion is located between the loops of the intestine and the anterior abdominal wall. Due to the contraction of the muscles of the abdominal press, there is a tension in the intestinal tissue and its mesentery. With excessive physical exertion, this can lead to the formation of an obstruction. Discomfort is caused by approximately the same reasons as pain.

The diagnosis of adhesions is based on the collection of numerous complaints. Some people may not have pain or discomfort at all. But constant constipation and the presence of a large abdominal operation in the past should give rise to the idea of \u200b\u200ban adhesive process. Stool disorders occur due to chronic damage to the intestinal wall and decreased motor activity. The consequence of such changes is a slowdown in the movement of chyme along the intestinal tube. In the future, the process of the final formation of feces and a decrease in the frequency of excretion of feces are delayed.

General manifestations of the disease

Intestinal adhesions are manifested by symptoms - both local and general. These include persistent weakness, a range of mental disorders, and decreased immunity. There are several reasons for these manifestations:

Constant pain and discomfort in the abdomen lead to depletion of the nervous system and form the so-called "core" of psychological changes in consciousness.
Disruption of normal bowel motility leads to a decrease in the flow of nutrients into the bloodstream.
Long-term presence of feces in the large intestine contributes to the increased reproduction of microorganisms in its lumen.

The occurrence of pain both during movements, physical exertion, and at rest contributes to the formation of protective behavior. It manifests itself in the fact that the patient tries to avoid a certain movement, posture or behavior. Accordingly, the normal spectrum of activity is limited. This can affect the sphere of professional activity, which ultimately leads to some exclusion from social contacts.

In addition, a belief is formed in the mind that this condition is caused by the actions of medical personnel, so in the future it is worth avoiding seeking medical help. All this together leads to a delay in proper care and worsening of the condition.

Intestinal adhesions, disrupting intestinal motility and reducing the absorption of nutrients, are mainly associated with a violation of the human nutritional status. Chronic insufficiency of proteins, fats and carbohydrates occurs. The consequence is weight loss and decreased immune status. However, this is by no means typical for all persons who have developed adhesions as a result of the operation. The addition of vitamin deficiencies significantly complicates the course of the underlying disease and can contribute to the addition of secondary bacterial complications.

Complications of the disease

In addition to nutritional disorders, vitamin deficiencies and mental disorders that develop over the years, it is possible to complicate the course of the adhesive process with severe and often life-threatening conditions:

acute intestinal obstruction.
intestinal necrosis.

Acute intestinal obstruction develops when the adhesion deforms the intestine so much that its patency practically disappears completely. In this case, there is an acute cramping pain in the abdomen. A fairly clear localization of pain at the site of obstruction is possible. This pain can be easily distinguished from the usual course of the disease, which is associated with its severity and suddenness, and not with any movement or position of the body.

Vomiting very quickly joins. At first, the vomit has signs of previously eaten food, but after a while there are impurities of bile. And in the absence of treatment, the vomit becomes fecal (since the contents of the intestine can no longer move in the physiological direction). Occasionally there is blood in the stool. Of the common manifestations, the following are distinguished:

in the first place is expressed general weakness;
body temperature rises;
the patient's facial features sharpen;
the skin becomes gray;
eyes sink;
in the absence of urgent surgical care, death occurs within a few days.

An equally serious complication is intestinal necrosis. In the pathogenesis of this condition, tissue clamping of adhesions of blood vessels and impaired blood flow in the intestinal area with the development of ischemia (oxygen starvation), and later - tissue death.

The main manifestation is increased abdominal pain and sudden bloating. Vomiting may join. The temperature rises significantly, chills appear. Due to the violation of the barrier functions of the intestine, microorganisms gain access to the systemic circulation. As a result, sepsis develops, which requires urgent medical intervention. Otherwise, death will occur within a few hours or days.

Treatment methods

Treatment of adhesions after surgery is a serious, lengthy and controversial issue. The occurrence of complications is an absolute indication for surgical treatment. At the moment, for this purpose, numerous techniques are used: starting with the intersection of individual elements of the adhesive tissue (in the absence of necrosis in the intestinal wall) and ending with excision of the intestinal area that has undergone necrotic changes.

If the issue of surgical treatment of intestinal adhesive disease is resolved, then a full and comprehensive preparation of the patient for surgery is necessary, aimed at correcting the disturbed metabolic links and compensating for all concomitant diseases. The surgeon's goal is to remove as much of the adhesion-forming connective tissue as possible. However, this procedure is exclusively temporary in nature, since even after the adhesions are removed, areas of tissue remain, which can later "stick together" again, and the symptoms of adhesive disease return.

There are many controversial opinions on how to treat adhesions formed after surgery in a conservative way (without surgery). However, all experts agree that a radical cure is possible only by removing the adhesions themselves. The attending physician can offer a number of techniques that, as a rule, will alleviate the patient's condition, but will not eliminate the cause. These include:

diet food;
periodic forced bowel cleansing;
symptomatic drug treatment.

The peculiarity of nutrition consists in eating food throughout the day in small portions, but often. Avoid foods that increase gas production (legumes, foods high in fiber).

Forced bowel cleansing means carrying out cleansing enemas. This procedure should be carried out as needed, but no more than 3 times a week. The drugs that can reduce the manifestations of the disease include antispasmodics (No-shpa and its analogues), pain relievers (Ketanov, Fanigan).

Disease prevention

Most patients are interested in how to avoid adhesions. Recommendations on this matter apply to both the doctor and the patient. Timely seeking medical help depends on the patient in order to prevent the development of complications that significantly aggravate the course of surgical pathology. In some cases, timely prescribed conservative treatment may have a sufficient effect, and surgical intervention is not required.

If, nevertheless, it is not possible to refuse the operation, then in many respects the prevention of the development of adhesions depends on the surgeon. However, it should be noted that even the most modern methods of surgical treatment and the best techniques do not provide an absolute guarantee. The likelihood of adhesion formation is reduced if minimally invasive interventions are performed, and all actions are carried out with the utmost care. Even if a section of the intestine is to be removed, it is necessary to carry out all measures to prevent the development of the adhesive process. Thus, the prevention of adhesions depends on both the doctor and the patient.

Possible causes, dangers, types of diagnosis and treatment of postoperative adhesions

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 and discomfort to a person, but 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.

Adhesions after surgery to remove the uterus: causes, symptoms and treatment

Adhesions concept

Connective tissue can look different. Namely, in the form of a film, scar, threads. These forms of tissue appear after strip surgery or after minimally invasive interventions.

Reasons for the formation of adhesions after removal of the uterus

The causal factors of this pathological condition are:

Additional trauma to adjacent anatomical structures.
If during a surgical operation the doctor left instruments, napkins, tampons, etc. in the abdominal cavity.
Infection during the operation, that is, the use of improperly processed instruments, or irregularities during dressings in the postoperative period.
The occurrence of such a complication after surgery as internal bleeding.
Activation of the inflammatory process.

In addition, the formation of adhesions is influenced by the incision during the operation, namely, the correctness of its implementation. The duration of the operation itself is also important.

Note! Medical practice shows that strains after removal of the uterus appear in women who are too thin.

How long does it take to form adhesions?

Symptoms and signs

In most cases, the presence of adhesions does not appear in any way. Symptoms appear when the situation becomes more complicated.

Additionally, there will be such symptoms:

general malaise and hypotension;
pain in the lower abdomen;
in the future, the patient's condition is complicated by frequent bouts of nausea and vomiting;
soreness of the postoperative suture;
the postoperative suture becomes inflamed - it melts bright red, edematous;
sometimes there is a fever;
pain after intercourse.

Diagnostics

Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
Ultrasound of the abdomen and pelvis allows you to assess the location of the organs. The doctor may assume that there is a lesion with connective tissue, since the organs will be incorrectly located.
Diagnostic laparoscopy is a minimally invasive method that allows you to fully visualize organs and other structures using a special manipulator.

Danger of adhesions

Dangerous complications are:

intestinal obstruction of acute form;
necrotic intestinal lesion;
peritonitis.

Treatment

Physiotherapy has also proven its effectiveness. They are used both for the prevention of the manifestation of adhesions, and already in their presence.

Physiotherapy

Electrophoresis is one of the physiotherapy procedures that can destroy postoperative adhesions. And also has a pronounced effect, that is, the symptoms are removed. Usually prescribed procedures. Electrophoresis is used in conjunction with pain medications.

In addition, paraffin and ozokerite applications are used. Today, laser therapy and magnetotherapy are popular methods of treatment.

Enzyme preparations

Fibrinolytic agents are very effective in the presence of adhesions, since they contain enzymes that can dissolve fibrin. These include:

Urokinase - breaks down blood clots by dissolving them.
Fibrinolysis - this substance is capable of dissolving fibrin.
Chemotrypsin is an agent that helps to thin the viscous exudate and thickened blood. The active substance breaks down fibrous deposits and necrotic tissue.
Hyaluronidase (Lidase) - this drug contains hyaluronic acid in its composition. The action is aimed at softening scars, as well as for the treatment of hematomas.
Streptokinase - this agent is able to dissolve blood clots, or rather dissolve fibrin in blood clots.
Trypsin.

Laparoscopy

A strip surgery to remove adhesions is called a laparotomy.

Prevention

Follow a diet.
Correctly care for the postoperative suture so that there is no infectious infection of the wound.
Avoid excessive physical exertion, but you need to move more.

If all these rules are followed, then the risk of adhesions is reduced.

Conclusion

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Principles of prevention of adhesive disease in the small pelvis

The adhesion process and the formation of adhesions in the abdominal cavity and pelvic organs is a universal protective and adaptive mechanism. It is aimed at delimiting the pathological site, restoring the anatomical structure of the tissues themselves and their blood supply, disturbed as a result of trauma and / and the inflammatory process.

Often, the formation of adhesions does not lead to pathological changes in the abdominal cavity and remains unnoticed. At the same time, their formation during inflammatory processes in the appendages often leads to infertility, and therefore, for example, the prevention of sexually transmitted diseases, or timely and adequate anti-inflammatory therapy is at the same time the prevention of adhesions in the fallopian tubes and, accordingly, prevention infertility.

Reasons for the formation of adhesions after surgery in gynecology and obstetrics

Traditionally, the adhesive process is considered a local tissue disorder, which occurs mainly as a result of surgical trauma to the peritoneal surfaces and subsequent inflammatory reactions.

The latter causes a cascade of corresponding processes in the form of exudation (effusion) of the liquid part of the blood, metabolic disorders in tissues, desquamation of the peritoneal epithelial layer of cells, fibrin deposition, the formation of elastin and collagen fibers, the growth of the capillary network at the site of damage and the formation of adhesions.

Drying of tissues, hypoxia of the mesothelium with the use of pneumoperitoneum with the use of carbon dioxide and surgical manipulations with tissues play a significant role in these processes.

Most often (in 63-98% of all cases) the formation of pathological intra-abdominal and pelvic adhesions (adhesions) between the surfaces of organs and the inner surface of the abdominal wall in the abdominal cavity occurs after an abdominal operation, in particular, in the pelvic cavity. They are one of the most important and not fully resolved problems of celiac surgery, occupying one of the leading places in the structure of postoperative complications.

The presence of adhesions may be asymptomatic. Their clinical symptoms are considered as adhesive disease, manifested by:

acute or chronic forms of adhesive intestinal obstruction;
dysfunction of the abdominal and pelvic organs;
chronic pelvic pain, or abdominal-pelvic pain syndrome;
violations of the menstrual cycle and tubal-peritoneal infertility (in 40% of cases) in women of reproductive age.

Prevention of adhesion in the small pelvis allows you to avoid or significantly reduce the likelihood of developing adhesive disease. The main causes of adhesions after surgery are damage to the superficial epithelial layer (mesothelium) covering the internal organs, as a result of:

mechanical impact, leading to trauma to the peritoneum at various stages of the surgical operation - dissection of the abdominal cavity, fixation of tissues and stopping bleeding by grasping with clamps and other instruments, excision of individual sections of the peritoneum, wiping and drying with dry gauze swabs and napkins, etc.;
the effects of various physical factors, which include drying of the serous membrane under the influence of air, especially with the laparotomic method of access, burns using an electric and radio wave knife, laser radiation, a plasma scalpel, electrocoagulation and other methods of coagulation of small bleeding vessels, washing with hot solutions;
aseptic inflammatory process in the abdominal cavity under the influence of previous factors, as well as intraperitoneal hematomas and minor hemorrhages, treatment of the peritoneum with alcohol or iodine, the use of various other concentrated solutions (antiseptics, antibiotics) for washing the abdominal cavity;
the use of absorbable suture material for a long time, the presence of drains in the abdominal cavity, talc from gloves, gauze or cotton pieces, etc.;
oxygen deficiency of tissues and disorders of metabolic processes in them, as well as inappropriate temperature regime of gas when using CO 2 -pneumoperitoneum for diagnostic or therapeutic laparoscopy;
postoperative infection that occurs more often with laparotomy access than with laparoscopic access.

All of these factors, and most often their combination, are a triggering mechanism leading to inflammatory processes, which are the cause of excessive biological synthesis of connective tissue, that is, the formation of adhesions. In operative gynecology, the maximum effect of the first three factors occurs during hysterectomy, and therefore the prevention of adhesions after removal of the uterus is of the greatest importance in comparison with other gynecological operations.

In obstetrics, delivery by cesarean section is somewhat less associated with mechanical and physical damage to the pelvic organs. However, the frequently occurring surgical blood loss causes tissue hypoxia, a violation of their metabolism and the body's immune response, which also contributes to the development of adhesions and adhesive disease in the immediate or late postoperative period. Therefore, the prevention of adhesions after cesarean section should be carried out in the same way as with other surgical interventions.

Methods for the prevention of adhesive disease

Based on observations and taking into account the mechanisms of the formation of the adhesion process, the prevention of adhesion formation should be carried out already during the surgical intervention itself. It includes the following basic principles:

Reduction of damage to the peritoneum due to careful treatment of tissues, reduction (if possible) of the operation time, economical use of coagulation techniques and retractors. In addition, it is necessary to reduce the number of sutures and apply clips, thoroughly stop bleeding without disturbing blood circulation in the tissues, remove all necrotic tissues and blood accumulations, suppress infection with low-concentration antibacterial and antiseptic solutions, moisturize tissues and wash the abdominal cavity, use suture material that does not cause immunological reaction, preventing the ingress of glove talc and cotton dust from gauze napkins and tampons into the abdominal cavity.
Reducing the severity of inflammatory processes through non-hormonal and hormonal anti-inflammatory drugs.
Decreased primary response to aseptic inflammation.
Suppression of the cascade of increased blood clotting, a decrease in the activity of fibrin formation and activation of processes aimed at its dissolution.
The use of funds aimed at reducing the accumulation of elastin and collagen proteins, which subsequently leads to the development of fibroplastic processes (fibrinolytic enzymes).
Application of the method of hydroflotation, which consists in introducing crystalloid solutions (Ringer's lactate solution) or dextrans (icodextrin, etc.) into the abdominal cavity together with heparin and a solution of glucocorticosteroids in order to separate the contacting surfaces, activate the fibrinolytic activity of peritoneal cells and suppress the coagulation cascade.
The use of barrier drugs (gels, biodegradable membranes, hyaluronic acid, polyethylene glycol, as well as the introduction of surfactant-like agents, etc.), which are fixed on the contacting surfaces in the abdominal cavity and in the small pelvis and lead to their mechanical separation.

Thus, the most important mechanism in the prevention of adhesions is to minimize the trauma of surgical intervention. Surgical methods of prevention can be supplemented by other means and methods that in no case can replace the first. In this regard, the prevention of adhesions during laparoscopy has significant advantages.

The main advantages of the laparoscopic method in surgical gynecology as a way to reduce the formation of adhesions are:

the minimum degree of trauma to blood loss due to the absence of large incisions of the anterior abdominal wall in areas of abundant blood supply;
minimal access, helping to prevent the possibility of penetration of ambient air and foreign reactive materials into the abdominal cavity, as well as drying of the serous surface with the destruction of the phospholipid layer;
the use of bipolar electrodes, which are significantly less damaging to tissues, compared to monopolar and ultrasonic ones, and prevent the formation of adhesions;
work on organs and tissues enlarged by an optical camera, using instruments at a remote distance, thereby significantly reducing the risk of mechanical injury to the mesothelial layer;
reduction of manipulations with distant organs and tissues;
no need to isolate individual zones and floors of the abdominal cavity, for example, the intestines, with surgical napkins;
more gentle and faster restoration of anatomical structures and intestinal peristaltic function;
the positive effect of the laparoscopy itself on the activity of the peritoneum in terms of fibrinolysis (dissolution of fibrin).

At the same time, according to statistics, about 30-50% of all cases of pelvic pain occur after laparoscopy of the ovarian cyst, fallopian tubes and other diagnostic laparoscopic procedures. This is mainly due to the fact that:

carbon dioxide, introduced into the abdominal cavity to provide laparoscopic access, causes a spasm of the capillaries of the superficial peritoneal layers, which leads to hypoxia and disruption of metabolic processes in the mesothelial layer; the addition of 3 percent oxygen by volume to carbon dioxide significantly reduces these phenomena;
gas is introduced into the abdominal cavity under pressure;
dry gas.

Thus, laparoscopic gynecology only slightly reduces the frequency and prevalence of adhesive processes, abdominal-pelvic pain syndrome and the frequency of repeated operations associated with adhesive disease. Laparoscopic methods are not a reason to abandon the basic principles of adhesion prevention. The choice of additional anti-adhesion agents depends on the extent of the surgical injury.

Prevention of adhesive disease in the postoperative period consists mainly in:

restoration of water and electrolyte balance in the body;
anti-inflammatory and anticoagulant therapy;
early activation of the patient;
the fastest possible restoration of intestinal function.

The principles for preventing adhesion formation are the same for all types of surgical interventions. Their use should be comprehensive and in accordance with the volume and nature of the injury.