An adhesion is a band of scar tissue that binds 2 parts of your tissue together. They should remain separate. Adhesions may appear as thin sheets of tissue similar to plastic wrap or as thick fibrous bands. The tissue develops when the body’s repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation.
Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery. Abdominal adhesions also occur in 10.4% of people who have never had surgery. Depending on the severity of the adhesion and the location, the indication of pain can differ. However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.
Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years. As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult. The bowel may become blocked. In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.
Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery. Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes. A woman’s eggs pass through her fallopian tubes into her uterus for reproduction. Fallopian adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops outside the uterus.
Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly. As a result, people experience many complaints based on where an adhesion forms and what it may disrupt. Typically, adhesions show no symptoms and go undiagnosed.
Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.
– Adhesions above the liver may cause pain with deep breathing.
– Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
– Adhesions involving the vagina or uterus may cause pain during intercourse.
It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
Depending on Dr. Nezhat’s recommendation for diagnosis, plain abdominal x-rays may reveal the small obstructions caused by adhesions. If pain is the only symptom and there is no evidence of obstruction, many other tests may be done to confirm the diagnosis. Visually examining the various areas and levels of the abdomen or pelvis with various scopes (endoscope, colonoscope, sigmoidoscope, proctoscope) can identify strictures probably due to adhesions. MRI evaluation may be useful in some cases. In cases in which the diagnosis is questionable, surgical exploration and visualization, either by laparoscopy or laparotomy, may be the definitive diagnostic test.
Adhesions within the abdomen and pelvis are treated by minimally invasive surgical techniques (laparoscopy). Lysis of adhesions can be performed as a part of other procedures (such as removal of ovarian cysts or fibroids), or as a procedure by itself. Although some believe that adhesions are a contraindication to performing laparoscopy, this belief is truly a misconception. Laparoscopy offers several advantages over laparotomy (“open” abdominal approach) in the treatment of adhesions. The laparoscope allows excellent visualization and magnification of the adhesions and the affected abdominal/pelvic organs. In addition, the CO2 gas which is used to inflate the abdomen provides a natural separation of the abdominal structures, allowing the adhesions to be clearly defined and effectively treated. The microsurgical principles which are employed with a laparoscopic approach also are much more effective in preventing the development of adhesions from the surgery itself.
Recovery from lysis of adhesions is fast as patients are usually discharged from the hospital within 24 hours and a return to normal daily activities can be expected within 1-2 weeks.
To find out more information on Adhesions, or to find out if you are a good candidate for the treatment of this condition, contact a representative at Nezhat Medical Center to request an in-office consultation with Dr. Ceana Nezhat.