Overview of Adhesiolysis
Adhesions are sort of like bridges of scar tissue that can form between different organs or layers of tissue within the body. These usually happen as a result of some kind of inflammation or irritation, which the body responds to by laying down this scar tissue as a way of healing. The most common cause of adhesions is surgery.
This scarring can appear pretty much anywhere in the body, such as the abdomen or chest cavity, within the eye, or around joints. Whether or not they cause problems really depends on where they form. Some adhesions might play a helpful role in the body’s healing process, while others can lead to severe complications if they bind organs or tissues together that are normally separate.
Common issues that can be caused by adhesions include chronic pain, infertility, blockages in the intestine, or decreased flexibility in a joint. Adhesions within the abdominal and pelvic areas are among the most common types, and will receive the most focus during this discussion.
Every time a surgery is performed or another cause of inflammation such as trauma or bleeding occurs within the belly, there’s the chance that adhesions will form. While these adhesions are part of the body’s process for healing and preventing further injury, they can also bring about negative effects like blockages in the intestines. Sometimes, a surgery may be needed to cut away these adhesions and resolve the blockage, which is a process known as adhesiolysis. This procedure, while less common, can also be done to relieve other symptoms such as pain or pressure on other structures within the body.
Anatomy and Physiology of Adhesiolysis
Adhesions are like scar tissue that forms inside your body between organs or other structures following an injury or inflammation. They change over time, much like the process your body goes through to heal a wound. At the start, they are fragile and swollen because inflammation causes a substance called fibrinogen to leak out and turn into fibrin. This fibrin mixes with another substance called fibronectin to create a temporary bed for the healing wound.
Over time, about 6 weeks, this tissue becomes more firm and compact, turning into mature fibrous tissue. The decision to treat these adhesions, if at all, depends on what caused them, where they are located, and what symptoms they are causing. There’s a surgical procedure called adhesiolysis that a doctor might recommend. This treatment involves making cuts to release these bands of scar tissue to prevent the problems they may be causing.
Why do People Need Adhesiolysis
Adhesiolysis is a medical procedure that breaks down or removes scar tissues, known as adhesions, in the body. It’s important to know that it isn’t usually a standalone treatment and often accompanies other surgeries. It should also be noted that while this procedure helps, adhesions can grow back after adhesiolysis, though they may look or feel different. Due to this, doctors only recommend adhesiolysis when it’s truly needed.
There are several situations when adhesiolysis might be necessary:
- Most commonly, it is performed when scar tissues cause a blockage in the intestines, known as a bowel obstruction.
- Adhesiolysis can help if scar tissues are trapping or causing issues to other body parts such as nerves, blood vessels or the ureter, the tube carrying urine from kidneys to bladder.
- If a patient experiences chronic abdominal or pelvic pain that cannot be explained by other conditions, then adhesiolysis might be considered. However, it should be the last resort after ruling out all other potential causes of the pain, as it may not always relieve the pain.
- Fertility issues can sometimes be improved by performing adhesiolysis if adhesions are the cause. It is considered as a potential option in these situations.
- Scar tissue might need to be removed as a pre-surgery step for other procedures, including hernia repair.
However, the best way around these problems is by preventing them in the first place, which could help avoid the need for adhesiolysis. Doctors and researchers are constantly looking for ways to reduce the formation of adhesions after surgeries. Some preventive measures include using products like Seprafilm to minimize adhesions, careful handling of tissues during surgery, avoiding contamination, ensuring proper blood clotting (hemostasis) and using non-irritating materials. Additionally, minimally invasive surgeries often result in fewer adhesions compared to traditional open surgeries.
When a Person Should Avoid Adhesiolysis
Adhesions, which are sticky bands of tissue that can cause organs to stick together, can sometimes form after radiation therapy. These adhesions often blend with normal tissues and are tougher than usual. The inflammation in the blood vessels that often accompanies radiation treatment can make separating these adhesions from other tissues more difficult.
Also, it can be hard to distinguish between normal and affected tissues. Any damage to normal tissues may not heal well because radiation can weaken the tissue’s ability to recover. Performing surgery on fresh adhesions (that are like fibrous bands) developed immediately after a surgery (maybe within 2 to 3 weeks) can be risky. It might cause distortions in normal tissues and might even lead to multiple tears or holes in the gastrointestinal tract, the system involved in digestion.
If these adhesions occur due to cancer, they usually have to be removed completely with the surrounding tissue. This is because there is a high chance the adhesions could contain invasive cancerous cells from that local area.
Equipment used for Adhesiolysis
When it comes to the removal of adhesions (bands of fibrous tissue that can develop between tissues and organs), doctors often choose to use laparoscopic (performed through small incisions using a special viewing instrument) or robotic techniques. These methods are less invasive and hence cause less pain, reduce hospital stay, and also lessen the chances of future adhesion formation. Physicians must be extra careful during the procedure as parts of your small intestine and adhesive structures may be stuck to your abdominal wall and can be harmed easily.
The first step into the abdomen for the laparoscopic procedure is usually done using an open technique, which is considered safe especially when there’s a high presence of adhesions.
Removing adhesions is typically done with fine dissection using scissors, with or without an energy source. An electrical hook that burns tissues is more common in non-invasive procedures. However, care must be taken to not allow the heat to spread sideways and harm other tissues.
Recently, advanced bipolar electrosurgical tools like Ligasure or Ultrasonic shearing devices such as the Harmonic scalpel have been efficiently used. They cause less bleeding and speed up the procedure, but, it’s necessary to use these tools correctly and stay within the normal tissue layers. Sometimes, it might be necessary to use clips or ties to secure blood vessels.
If there are any tears in the bowel’s surface or damages to the capsules of the organs, they might need individual attention to stop any bleeding and maintain the normal functioning of the organs. Sometimes, ‘Seprafilm’, a dissolvable membrane made of hyaluronic acid and carboxymethylcellulose, is used to help reduce the likelihood of future adhesion formation.
Several studies have shown that a modified barrier made of sodium hyaluronate/carboxymethylcellulose is safe and can reduce the chance and severity of future adhesions. This is, however, not routinely used. Additionally, the general shift towards less invasive procedures has significantly cut down the development of new adhesions.
How is Adhesiolysis performed
A minimally invasive process allows doctors to better see and access various parts of the abdominal cavity. This is done with only small cuts, so there’s less damage to the body. The doctor needs to go into an area that is likely to have few tissues stuck together, places these are called adhesions, and less likely to have organs. This area is typically the upper left part of the abdomen.
Once the doctor is inside the abdomen, they will need to create enough safe zones for the rest of the equipment. They do this by separating easy-to-reach adhesions. It’s crucial to note that they should only separate these tissues if necessary, to keep from causing harm to healthy tissues.
If there is a blockage in the small intestine,the doctor will check the small bowel starting from where the small and large intestine meet. This area is known as the ileocecal valve, moving towards the stomach until the blockage is found. Once the blockage has been taken care of, the rest of the bowel needs to be examined with minimal interference. It’s recommended to avoid excessive separation of adhesions. When the procedure is finished, it’s important to make sure all bleeding has stopped.
Possible Complications of Adhesiolysis
During surgery to break down scar tissue within the body (adhesiolysis), unintentional harm to the bowel might occur in up to 10% of patients. This unexpected damage might cause intestinal content to seep into the area being operated, leading to severe infections known as surgical site infections or intra-abdominal abscesses (a pocket of pus). These issues can force a longer hospital stay, escalate healthcare costs, and increase the overall patient risk.
Catching these complications early, even during the operation, is very important.
Like anyone who has undergone a surgical procedure, those who have had adhesiolysis might be susceptible to usual post-operative problems. These can include deep vein thrombosis (blood clots within deep veins), atelectasis (collapsed lung or air sacs), surgical site infections, and urinary tract infections.
Close monitoring of all potential complications is crucial, and the healthcare team needs to manage risks with preventive steps. These might include using a device to encourage coughing and deep breathing (incentive spirometry), preventing blood clots (DVT prophylaxis), and timely removal of the Foley catheters (tubes inserted into the bladder to drain urine), when suitable.
What Else Should I Know About Adhesiolysis?
Adhesions, which are bands of scar-like tissue that form between internal organs and tissues, are a significant health concern. They are estimated to cause around 300,000 hospital stays each year in the United States, costing roughly 1.3 billion dollars annually to diagnose and treat.
That’s why it’s important for healthcare workers to understand how to manage adhesions. Management usually involves non-surgical treatment, breaking down the adhesions through a process called adhesiolysis (only when necessary), and providing the right care after surgery.
