Lysis of Adhesions (Cutting Adhesions, Adhesiolysis)

Definition

Lysis of adhesions is the process of cutting scar tissue within the body to restore normal function or appearance.

Parts of the Body Involved

  • Abdomen
  • Pelvis

Reasons for Procedure

Adhesions are scar tissue that forms within the body, usually within the abdomen or pelvis. Adhesions develop naturally after surgery as part of the healing process. Adhesions can also develop after infection or any other inflammatory process such as endometriosis, diverticulitis, or appendicitis. Adhesions can cause pain, obstruction of the bowel, and infertility. Cutting the adhesions may stop or reduce these problems.

Risk Factors for Complications During the Procedure

  • Pre-existing heart or lung condition
  • Obesity
  • Major abdominal surgery in the past
  • Smoking history
  • Diabetes

What to Expect

Prior to Procedure

Your doctor will perform a physical exam and will probably order some of these tests:

  • Blood Tests
  • Ultrasounda test that uses sound waves to visualize the inside of the body
  • CT Scana type of x-ray that uses a computer to make pictures of the inside of the body
  • MRI Scana test that uses magnetic waves to make pictures of the inside of the body

In the days leading up to your procedure:

Review your regular medications with the surgeon; you may need to stop taking some drugs. Arrange for a ride to and from the procedure. The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor. Wear comfortable clothing. Anesthesia The doctor may choose to use a local anesthetic with sedation or general anesthesia. Description of the Procedure Lysis of adhesions is usually performed during a laparoscopy. After you receive the anesthesia, the doctor will make several small incisions in the wall of your abdomen. The doctor will then use a fiberoptic instrument to see inside. If there are any adhesions, your doctor will cut them. Doing so will free those organs (such as the ovaries) that were caught in the adhesions. If open abdominal surgery (laparotomy) is needed, you will receive a general anesthetic, and a larger incision will be made in the abdomen to allow the surgeon direct access to all the organs. It is not unusual for a laparoscopy to be converted to a laparotomy during the same operative session. How Long Will It Take? The surgery will take between 1 to 3 hours. Will It Hurt ? The injection of local anesthetic may sting or burn. The procedure itself usually does not hurt. You may experience soreness for a couple of days during recovery, but you will receive pain medication to relieve this discomfort. If a laparotomy has been performed, you will have more pain, and the surgeon will give you more pain medicine.
Possible Complications Injury to the following: Bowel Bladder Blood vessels Ureters (tubes that carry urine from the kidney to the bladder) Worse adhesions Bleeding Infection Average Hospital Stay You may or may not stay overnight, depending on the extent of surgery. Open laparotomy will usually require up to a week in the hospital. Postoperative Care When you return home after the procedure, do the following to help ensure a smooth recovery: Follow your doctors instructions for care of the incision site. Take pain medications as directed by your doctor. Avoid heavy lifting. Do not drink carbonated beverages for two days. Outcome Cutting adhesions can fix intestinal blockage and treat infertility caused by adhesions. The procedure reduces chronic abdominal pain in about 45% of individuals. Call Your Doctor If Any of the Following Occurs It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor: Signs of infection, including fever and chills Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site Cough, shortness of breath, chest pain, or severe nausea or vomiting RESOURCES:
American College of Surgeons http://www.facs.org International Adhesions Society http://www.adhesions.org CANADIAN RESOURCES: Canadian Medical Association Journal http://www.cmaj.ca The Society of Obstetricians and Gynaecologists of Canada (SOGC) http://www.sogc.org References: A patients guide to adhesions and related pain oryou are not alone. International Adhesions Society website. Available at: http://www.adhesions.org/ptguide_print.htm . Accessed September 16, 2005. Dunker MS, Bemelman WA, Vijn A, et al. Long-term outcomes and quality of life after laparoscopic adhesiolysis for chronic abdominal pain. J Am Assoc Gynecol Laparosc . 2004;11:36-41. Kumar V, Abbas AK, Fausto N. Robbins and Cotran Pathologic Basis of Disease . 7th ed. Philadelphia, PA: Elsevier; 2005. Lamvu G, Tu F, As-Sanie S, et al. The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain. Obstet Gynecol Clin N Am . 2004;31:619-630. Saravelos HG, Li TC, Cooke ID. An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for chronic pelvic pain. Hum Reprod . 1995;10:2895-2901. Stenchever MA, Droegemueller W, Herbst AL, Mishell DR, eds. Comprehensive Gynecology . 4th ed. St. Louis, MO: Mosby; 2001.
Last reviewed November 2007 by Daus Mahnke, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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