Adhesions
Learn adhesions
What are adhesions? Why would adhesions?
Abdominal cavity and pelvic cavity inner wall surface with a layer of transparent film, known as the peritoneum. Peritoneum is avery thin,and highly ductilitylayer, covering the bladder, uterus, fallopian tubes and part of the intestinal surface. Other organs, such asovarian, liver, gall bladder, stomach, spleen and part of the intestine, are located inside the peritoneum. Peritoneum has a lubricating effect, which helped organs move smoothly.
The healing process will likely
toproduceadhesionwheneverduring
peritoneal inflammation or damage.Adhesionoccurredas a strip of
scar tissuethat adhere organsandsurroundingtissuesin whichthey areoriginallyseparated insidethe
pelvic-abdominal cavity.Adherent tissue may
show as a filmor, may be as
athick fibrousformation. The most common cause of
injury is peritoneal surgery. During all of the
abdominal and pelvic surgery, surgical instruments were used to cut,
touch or handle organs inside the cavity, in whichalmost
impossible to avoid peritoneal damage. According to researchstudies,
about 93% of abdominal surgery patients will have adhesions 1. In
addition, pelvic inflammatory disease, endometriosis or individual patient
physical factors, may also likely to cause tissue
adhesions.
Postoperative adhesions can cause the problem?
You may not know adhesion has occurredby yourself. In most cases, adhesions usually do not affectdaily activity, and are usually not diagnosed. However, adhesions sometimescan cause pain 2,3, infertility2,4, intestinal obstruction and other complications 2,3, may also cause other diseases. Symptoms mayoccur immediately after surgery, it may also be a few years after the operation. Patient sometimesmay need to perform another surgery to remove adherent tissues, in order toimprovethe sequelae ofadhesions.
1/ Pain
Adhesions will "tie-down” organs and restrict themovementof organs, in whichcertainbody movementduring daily
activities,may cause abnormalnervestimulation 2,3, and end upcausing
chronic pelvic abdominal pain.
2/ Infertility
Ovarian and tubal adhesions are the main reasons of infertility, due to ovum cannot enter the uterus along the fallopian tubes, or prevent sperm into the fallopian tube. Research studies suggest that about 20-40% of infertility cases wererelated toadhesions 5.
3/ Intestinal blockage
Most serious consequences of adhesion
may cause intestinal obstruction. This becomes a severe diseasewhen, fecal material
is blockedin the digestive systemdue to
intestinal adhesion. Thiscan cause abdominal cramps,
nausea, and vomiting. Sometimes hospitalization may improve symptoms, however,
some cases mayrequire emergency surgery 5. According to the researchstudy,
65 to 75 % of intestinal obstructioncaseswere caused by adhesions6,7
Learn Solution
How to prevent adhesions?
In terms of procedure, the surgical team will try to avoid causing unnecessary harm to the peritoneum, and the prevention of anti-adhesions products, which are the necessary measures to reduce the chances of adhesion5. Prevention is better than cure, this sentence is particularly suitable to describe the solution ofadhesions.
What are the anti-adhesions or adhesion preventing product?
Currently on the market, there are several products prevent adhesions by separate organsin a form a barrier for a certain period after
surgery. There are two types of anti-adhesion productsfor physician: a
full range of anti-adhesion solution and local anti-adhesionbarrier
product.
Comprehensive anti-adhesion solution: Through hydration float (Hydroflotation) whichgave atemporary isolation peritoneal surfaces, in order to achieve comprehensive (broad coverage) anti-adhesion effectand leftnumber of days in the abdominal cavity 8.The solution will mixed withintra-abdominal peritoneal fluid and absorbed by human body.
Local solid anti-adhesion: including coated film sewn or gel that applied to the surface of the organ, to achieve local (site-specific) prevention of adhesions 8.
Reference
2.Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update 2001; 7: 567-76.
3.Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynaecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol 1994; 170: 1396-403.
4.Mishell DR. Davajan V. Lobo RA. eds. Infertility, contraception and reproductive endocrinology. 3d ed. MaIden, MA: Blackwell Scientific, 1991: 557-70.
5.Brown CB, et al. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertility and Sterility 2007;88:1413-26.
6.Ellis H. Medicolegal consequences of postoperative intra-abdominal adhesions. J R Soc Med 2001;94:331-32.
7.Ellis H. The magnitude of adhesion related problems. Ann Chir Gynaecol 1998;87:9-11.
8.Sutton C, Minelli L, Garcia E et al. Use of icodextrin 4% solution in the reduction of adhesion formation after gynaecological surgery. Gynecol Surg 2005;2:287-96.