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Adhesions


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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


1.Menzies D, Ellis H. Intestinal obstruction from adhesions how big is the problem? Ann R Coll Surg EngI 1990; 72: 60-3.


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.