How to treat adhesions after surgery for women. Reasons for the formation of adhesions after surgery? What are knee contractures?

Adhesions are connective tissue that grows in the abdominal and pelvic cavity. It connects organs and other structures to each other. Adhesions after surgery to remove the uterus appear quite often. Medical statistics indicate that they occur in 90% of cases. This condition is a complication that is dangerous to a woman’s health.

Collapse

The concept of adhesions

Adhesions are additional tissue, the peculiarity of which is the sticky fibrin it secretes. Because of this, this tissue glues organs together. This is due to the body’s protective reaction, that is, the proliferation of adhesions is necessary to maintain the diseased organ or tissues affected by the inflammatory process.

Connective tissue can look different. Namely, in the form of a film, scar, threads. These tissue forms appear after strip surgery or after minimally invasive interventions.

Reasons for the formation of adhesions after removal of the uterus

The formation of adhesions after removal of the uterus is a common occurrence, since the wound healing process is accompanied by the formation of a connecting scar. The space that has formed begins to be overgrown. The main reason for the occurrence of adhesions is the individual characteristic of the body, in which it does not produce the enzyme responsible for the resorption of fibrin deposits.

The causative factors of this pathological condition are:

Additional injury to adjacent anatomical structures.
If during a surgical operation the doctor left instruments, napkins, tampons, etc. in the abdominal cavity.
Infection during the operation, that is, the use of improperly processed instruments, or violations during dressings in the postoperative period.
The occurrence of complications after surgery such as internal bleeding.
Activation of the inflammatory process.

Additionally, the formation of adhesions is influenced by the incision during the operation, namely, the correctness of its execution. The duration of the operation itself is also important.

Note! Medical practice shows that cords after removal of the uterus occur in women who are too thin.

How long does it take for adhesions to form?

Adhesions begin to form from the accumulation of inflammatory fluid or blood that did not resolve after surgery. Moreover, their formation begins already from 7-21 days. The exudate gradually thickens up to this time and begins to be replaced by connective tissue. After 30 days, blood capillaries and nerve fibers are formed in it.

Symptoms and signs

In most cases, the presence of adhesions does not manifest itself in any way. Symptoms appear when the situation becomes more complicated.

The main symptoms include intestinal dysfunction. Namely, intestinal obstruction, which is manifested by pathologically infrequent bowel movements or complete cessation of stool passage. Constipation and flatulence are also observed.

Additionally, there will be the following symptoms:

general malaise and hypotension;
pain in the lower abdomen;
in the future, the patient’s condition is complicated by frequent attacks of nausea and vomiting;
postoperative suture pain;
the postoperative suture becomes inflamed - becomes bright red and swollen;
sometimes there is a fever;
pain after intercourse.

Diagnostics

Diagnosis of the adhesive process is difficult, since an accurate verdict is possible only after laparoscopy or full abdominal surgery. But a doctor may suspect the presence of adhesions after the following diagnostic methods:

Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
Ultrasound of the abdominal cavity and pelvis allows you to assess the location of organs. The doctor may assume that there is damage to the connective tissue, since the organs will be incorrectly located.
Diagnostic laparoscopy is a minimally invasive method that allows, using a special manipulator, to completely visualize organs and other structures.

When adhesions form after surgery to remove the uterus, an X-ray examination of the intestine is sometimes prescribed, especially if there is a complex of symptoms of organ dysfunction. Contrast agents are used for this. As a result, it is clear how narrowed the intestinal lumen is and what degree of intestinal patency.

The danger of adhesions

Adhesions themselves are a postoperative complication. They can cause serious consequences, since the spread of connective tissue contributes to disruption of the normal functioning of organs.

Dangerous complications are:

acute intestinal obstruction;
necrotic intestinal lesions;
peritonitis.

Treatment

When a woman has her uterus removed, she is prescribed preventive therapy. It includes a list of medications that also prevent the formation of adhesions. These include anti-inflammatory drugs, antibiotics and enzyme preparations,

Physiotherapy has also proven its effectiveness. They are used both to prevent the manifestation of adhesions, and even if they are present.

Physiotherapy

Electrophoresis is one of the physical procedures that can destroy postoperative adhesions. It also has a pronounced effect, that is, symptoms are relieved. Usually 10-12 procedures are prescribed. Electrophoresis is used together with painkillers.

In addition, paraffin and ozokerite applications are used. Today, laser therapy and magnetic therapy are popular treatment methods.

Enzyme preparations

Fibrinolytic agents are very effective in the presence of adhesions, since they contain enzymes that can dissolve fibrin. These include:

Urokinase - destroys blood clots, dissolving them.
Fibrinolysis - this substance is capable of dissolving fibrin.
Chemotrypsin is a means of thinning viscous exudate and thickened blood. The active substance breaks down fibrous deposits and necrotic tissue.
Hyaluronidase (Lidase) – this drug contains hyaluronic acid. The action is aimed at softening scars, as well as for the treatment of hematomas.
Streptokinase - this drug is capable of dissolving blood clots, or rather dissolving fibrin in blood clots.
Trypsin.

Laparoscopy

Laparoscopy is a surgical treatment related to minimally invasive interventions. This method involves the doctor making several small incisions through which instruments and a manipulator are inserted. During the operation, adhesions are dissected and blood vessels are cauterized. The doctor must also remove the synechiae. This is done using laser, aquadissection or electrosurgery.

A positive factor of this treatment is the minimal list of complications, which also occur extremely rarely. Also, rehabilitation after laparoscopy does not last long. The very next day after this operation, the woman can get up. The recovery period is no longer than several days.

A strip operation to remove adhesions is called laparotomy.

Prevention

The main prevention of adhesions is proper surgical treatment, without any violations, since adhesions form after operations. Incorrect rehabilitation methods can also affect the manifestation of cords. How to avoid adhesions? Doctors recommend after surgery to remove the uterus:

Follow a diet.
Properly care for the postoperative suture to avoid infection of the wound.
Avoid excessive physical activity, but at the same time you need to move more.

If all these rules are followed, then the risk of adhesions is reduced.

Conclusion

The adhesive process after surgery is quite dangerous. Therefore, if any symptoms occur, you should consult a doctor. After all, this pathological condition can lead to dangerous consequences.

Content

Hysterectomy or removal of the uterus is a common operation in modern gynecology. Surgery to remove or amputate the uterus is often performed in women after forty years of age. This is due to the fact that in patients of reproductive age, hysterectomy is performed only for serious indications.

Hysterectomy, which involves amputation or removal of the uterus, is performed in the following clinical cases:

uterine rupture during delivery;
intensive growth of benign tumors in women after menopause;
malignant tumors of both the uterus and appendages, as well as suspicion of an oncological process;
uterine prolapse in the presence of concomitant pathologies.

Sometimes the uterus is removed in case of extensive injuries in the pelvis and purulent peritonitis, which are characterized by a severe course. The issue of amputation of the uterine body is decided on an individual basis and depends, first of all, on the severity of the pathologies, the presence of other diseases, the age and reproductive plans of the patient.

Hysterectomy can be performed using several techniques.

The most common is supravaginal removal or amputation.
Extirpation of the uterine body with appendages involves amputation of both the cervix and both ovaries.
Total hysterectomy means removal of the uterus along with the appendages, cervix, ovaries, local lymph nodes and affected vaginal tissue. This type of removal is recommended for malignant uterine tumors.

Despite the prevalence of hysterectomy operations, hysterectomy is recommended for serious indications. This is due to the fact that uterine amputation has surgical and postoperative complications, as well as long-term consequences that significantly worsen a woman’s quality of life.

Gynecologists note the following surgical and postoperative complications.

Inflammation and suppuration of the postoperative suture. In this case, swelling, redness, and suppuration of the wound develops with possible symptoms of dehiscence of postoperative sutures.
Suture infection after surgery. Symptoms of infection include high fever and soreness. In order to prevent infection, the postoperative suture needs regular treatment.
Urinary dysfunction. In the early postoperative period, pain often occurs when emptying the bladder.

Bleeding. This complication can occur both during the surgical and postoperative periods.
Damage to neighboring organs. When amputating the uterine body, damage to the walls of the bladder and other organs is possible.
Pulmonary thromboembolism. This dangerous complication can cause blockage of the pulmonary artery with pieces of torn tissue.
Intestinal paresis. Occurs against the background of damage to the nerve fibers of the pelvis during surgery.
Peritonitis. This pathology means inflammation that has spread to the abdominal area. If this postoperative complication is not eliminated in time, there is a risk of developing sepsis. In this case, the woman experiences symptoms such as severe pain, loss of consciousness, sallow skin tone, intense sweating, and high fever. Treatment consists of antibiotics and removal of the uterine stump.

Later consequences include the following manifestations.

Loss of reproductive function. Removal of the uterus makes it impossible to carry a pregnancy.
Psycho-emotional disorders. Hormonal fluctuations cause an unstable emotional background, a depressed state, and irritability.
Decreased libido. A woman may notice a lack of sexual desire. Sexual life is characterized by pain and psychological discomfort.
The appearance of symptoms of early menopause. After amputation of the uterine body, symptoms such as sweating, hot flashes, and bone fragility appear.
Development of the adhesive process. After any surgical intervention, the appearance of adhesions is considered inevitable.
Cosmetic defect. Since amputation of the uterus most often occurs through abdominal surgery, a noticeable scar remains.

After removal of the uterus by hysterectomy, postoperative adhesions occur, which can lead to unpleasant symptoms, for example, pain, problems with defecation and urination, displacement of the pelvic organs, and prolapse of the vaginal walls.

Causes of occurrence after surgery

Adhesions after uterine amputation are one of the most unpleasant consequences of the postoperative period. According to statistics, adhesions after surgery occur in more than 90% of women. The adhesive process, despite its apparent harmlessness, is a serious postoperative complication. The danger of developing an adhesive process is that it can lead to serious illnesses and cause unpleasant symptoms.

If the adhesions are extensive, they are defined by the term “adhesive disease.” Gynecologists say that it is necessary to differentiate physiological and pathological adhesive processes.

During hysterectomy, accompanied by amputation of the uterine body, connective tissue scars always appear. Such scars are physiological adhesions. However, if fibrous cords continue to grow and disrupt the functioning of neighboring organs, this pathology is called adhesive disease.

Fibrous cords are light in color and durable. In their structure, such adhesions resemble fibrous formations that connect organs.

The etiology and pathogenesis of adhesive disease have not been sufficiently studied. Typically, the appearance of adhesions is characteristic of large-scale operations involving amputation of several organs.

There may be several reasons for the formation. The formation of adhesions may be associated with the following factors:

duration of the operation;
volume of intervention and blood loss;
the presence of surgical and postoperative bleeding, which contributes to the appearance of adhesive disease;
infection in the period after surgery;
genetic predisposition, manifested in the absence of an enzyme that resolves fibrin deposits;
asthenic physique.

The actions of the gynecologist during the operation are essential in the formation of adhesions. It is important whether the incision was made correctly and the postoperative suture was applied.

In gynecological practice, it sometimes occurs that surgeons leave foreign objects in the peritoneal area during surgery.(gauze pads, tampons). This may contribute to the development of symptoms of adhesive disease after uterine amputation.

Symptoms when they occur

Adhesions after hysterectomy surgery are known to have symptoms. However, these symptoms of adhesive disease after hysterectomy are not always pronounced. Despite the fact that the severity of symptoms is individual, you can suspect adhesions after surgery to remove the uterus based on the following symptoms.

Pain. The woman notices aching and nagging pain, which can be relieved by taking painkillers. It is noteworthy that pain can be both constant and periodic, and also reach significant intensity.
Disturbances regarding urination and defecation. With adhesions, excretory function disorders are noted.
Symptoms of gastrointestinal disorders. Quite often, adhesions after removal of the uterine body are manifested by flatulence and excessive intestinal motility.
Increase in body temperature. Adhesions after hysterectomy can cause both high and low-grade fever.
Postoperative scar pain. An important symptom indicating the presence of adhesive pathology is pain when palpating the scar, as well as its swelling and redness.

Symptoms of adhesions also include pain during sexual intercourse. In some cases, bloody discharge from the genital tract may occur. Despite the presence of symptoms, examination is necessary to confirm the diagnosis.

Diagnostic methods for identifying

Diagnosis of adhesive disease after amputation of the uterine body is difficult. This is due to the fact that in most cases, an accurate diagnosis is only possible during laparoscopy or abdominal surgery.

The presence of adhesions after hysterectomy can be suspected after analyzing the patient’s symptoms and medical history. It is possible to confirm adhesive pathology using basic diagnostic methods.

Laboratory research. This is an additional examination method that involves a blood test; it helps to identify inflammation and assess the activity of fibrinolysis.
Ultrasound of the abdominal and pelvic organs. This examination method allows us to assume, and in some situations, to identify the presence of adhesions after hysterectomy by determining the incorrect position of organs that are “tightened” by adhesions.
X-ray of the intestines. The study is carried out using a contrast agent. This method is auxiliary, as it helps to assess both intestinal patency and narrowing of the lumen.
Laparoscopy. This method is optimal for diagnosing and treating adhesions after hysterectomy surgery. The surgical process involves dissection and removal of adhesive formations.

Diagnosis of adhesions after uterine amputation is individual and depends on the symptoms and characteristics of the medical history.

Surgical tactics for treatment

Adhesive disease is treated primarily with surgical techniques. This is due to the fact that conservative methods are ineffective and are used for preventive purposes, for example, in the postoperative period. Drug treatment is also used to eliminate unpleasant symptoms.

To eliminate adhesions after removal of the uterus, doctors use two types of operations:

laparoscopy;
laparotomy.

The operation using laparoscopy involves making several small punctures in the abdominal wall. These punctures are necessary for the use of special equipment during the operating period.

Laparoscopy has a number of advantages:

dissection of adhesions is performed under the direct control of the optical system;
tissue trauma is minimal;
cutting of adhesions with special instruments followed by hemostasis;
absence of symptoms such as severe pain and postoperative complications;
the recovery stage takes several days;
rapid disappearance of symptoms of adhesions;
possibility of physical activity the next day after surgery.

Gynecologists note that laparotomy is rarely used in the treatment of adhesions that arise after amputation of the uterine body. Laparotomy is used mainly in the following situations.

Lack of possibility of laparoscopic surgery.
Symptoms of extensive adhesive disease in the peritoneum.

The surgical stages of laparotomy involve the use of an inferior midline approach. Then surgeons expand its top to fifteen to twenty centimeters. This tactic is necessary for a thorough examination of all organs and removal of adhesions.

Laparotomy is considered a traumatic operation. This is due to the fact that such an operation has a significant risk of operational and postoperative complications. Relapses often occur after laparotomy surgery, and the recovery period lasts about a month.

Gynecologists advise following the recommendations of the treating doctor in the postoperative period and preventing the occurrence of adhesions. If you have reproductive plans, it is advisable to start planning a pregnancy after the end of the recovery period.

Prevention education

The risk of surgical and postoperative complications largely depends on the actions of the surgeon. In this regard, you should approach the choice of a doctor responsibly. The postoperative recovery period also depends on the progress of the hysterectomy.

Only absorbable thread should be used as material for suturing the incision. Hysterectomy is considered a fairly extensive and serious operation, and the threads are a foreign object - an antigen for the body. Over time, the threads become overgrown with connective tissue. Subsequently, the formation of adhesions begins. Accordingly, the nature of the adhesions also depends on the correct execution of the seam.

In the postoperative period after amputation of the uterine body, drug therapy is necessarily prescribed. The patient is recommended to take broad-spectrum antibiotics. These drugs prevent infection and inflammation. The use of anticoagulants is also advisable.

To eliminate symptoms after surgery, as well as to prevent adhesions, physical therapy is performed. In particular, electrophoresis destroys the formation of adhesions and reduces the severity of symptoms in the early postoperative stage.

After removal of the uterus by hysterectomy, the patient undergoes regular examinations, including pelvic ultrasound and gynecological examination.

Early motor activation of the patient after removal of the uterine body is essential. For example, walking may improve intestinal motility and reduce the risk of adhesions.

Surgical treatment involves following a proper diet. A woman should avoid spicy, salty and fried foods, as well as alcohol and carbonated drinks. An improper diet impairs digestion, which weakens intestinal motility.

Operational tactics involve fractional feeding. It is advisable to eat food in small portions six to eight times a day. Such a diet will not contribute to intestinal overload, and the possibility of formation of adhesions will be significantly reduced.

After discharge from the hospital, a woman must follow the doctor’s instructions, in particular, take prescribed medications and undergo physiotherapeutic treatment. In some cases, you can use folk remedies to prevent adhesions after surgery to remove the uterus.

Many people are familiar with the term adhesions firsthand. They appear after any strip operation, and subsequently cause a person considerable anxiety. We will consider whether it is possible to prevent the occurrence of adhesions, what complications the adhesions process can cause, and what treatment methods are available

The appearance of adhesions

Despite the big leap in the development of medicine, any patient after abdominal surgery can expect such an unpleasant complication as adhesions. What are spikes and why do they appear? The fact is that all organs of the human abdominal cavity are covered with a protective serous membrane. After surgery, this membrane is damaged, and during healing, adhesions are likely to occur. They are whitish translucent films that rigidly fix the internal organs and prevent them from interacting correctly. Most often, adhesive disease is not so serious as to cause significant harm to health. But in some cases it can cause a lot of inconvenience and decreased performance. Drawing, aching pain appears with a sudden change in body position; a feeling of discomfort and sometimes severe pain may occur.

Prevention

During operations performed on internal organs, extreme care is taken to prevent foreign material from entering the open wound and to avoid drying it out. If these conditions are not met, the risk of adhesions increases significantly. Their appearance is also facilitated by the patient’s low mobility after the operation, so physical activity should begin as early as possible - this will significantly reduce the risk of adhesions. It is imperative to adhere to the prescribed diet so as not to overload the body. A course of treatment with anti-inflammatory drugs is carried out in order to avoid infections of internal organs. Immediately after discharge, physical therapy will be very effective: ultrasound, laser treatment, electrophoresis.

Treatment

If adhesions have already formed or their occurrence cannot be prevented, treatment with surgery may be necessary. The most gentle method is laparoscopy: adhesive joints are dissected through a small puncture using a miniature video camera. If the lesion is large, a surgical incision must be made to remove the connective tissue.

You can also try to treat adhesions with folk remedies. For example, this article talks about traditional treatment of fallopian tube adhesions in women.

Consequences

Do not neglect the doctor's prescription after surgery. By refusing postoperative prophylaxis and physical therapy, the patient may encounter a number of complications associated with adhesive disease. Abnormal bending or partial narrowing of the intestine, up to obstruction, which may require urgent surgical intervention. In women, adhesions on the internal organs of the small pelvis can lead to the risk of inflammation of the appendages and even infertility.

Very often, after being discharged from the hospital, people rush to quickly return to their daily rhythm of life, work and household chores, without thinking about the risk of complications. In order to preserve your future health, you just need to pay attention to yourself, try to organize your daily routine, start eating right and don’t forget about physical exercise.

The adhesive process and the formation of adhesions in the abdominal cavity and pelvic organs is a universal protective and adaptive mechanism. It is aimed at delimiting the pathological area, restoring the anatomical structure of the tissues themselves and their blood supply, disturbed as a result of injury and/or inflammatory process.

Often the formation of adhesions does not lead to pathological changes in the abdominal cavity and goes unnoticed. At the same time, their formation during inflammatory processes in the appendages often leads to infertility, and therefore, for example, the prevention of sexually transmitted diseases, or timely and adequate anti-inflammatory therapy is simultaneously the prevention of adhesions in the fallopian tubes and, accordingly, the prevention infertility.

Reasons for the formation of adhesions after surgery in gynecology and obstetrics

Traditionally, the adhesive process is considered a local tissue disorder that occurs primarily as a result of surgical trauma to the peritoneal surfaces and subsequent inflammatory reactions.

The latter causes a cascade of corresponding processes in the form of exudation (effusion) of the liquid part of the blood, disruption of metabolic processes in tissues, desquamation of the peritoneal epithelial cell layer, fibrin deposition, formation of elastin and collagen fibers, growth of the capillary network at the site of damage and the formation of adhesions.

A significant role in these processes is played by tissue drying, mesothelial hypoxia when using pneumoperitoneum using carbon dioxide, and surgical manipulation of tissue.

Most often (in 63-98% of all cases) the formation of pathological intra-abdominal and pelvic adhesions (adhesions) between the surfaces of organs and the inner surface of the abdominal wall in the abdominal cavity occurs after abdominal surgery, in particular in the pelvic cavity. They are one of the most important and not fully resolved problems of abdominal surgery, occupying one of the leading places in the structure of postoperative complications.

The presence of adhesions may be asymptomatic. Their clinical symptoms are considered as adhesive disease, manifested by:

acute or chronic forms of adhesive intestinal obstruction;
dysfunction of the abdominal and pelvic organs;
, or abdominal-pelvic pain syndrome;
menstrual cycle disorders and (in 40% of cases) in women of reproductive age.

Prevention of adhesions in the pelvis allows you to avoid or significantly reduce the likelihood of developing adhesions. The main causes of adhesions after surgery are damage to the surface epithelial layer (mesothelium) covering the internal organs as a result of:

mechanical impact leading to trauma to the peritoneum at various stages of the surgical operation - dissection of the abdominal cavity, fixation of tissues and stopping bleeding by grasping with clamps and other instruments, excision of individual sections of the peritoneum, wiping and drying with dry gauze swabs and napkins, etc.;
exposure to various physical factors, which include drying of the serous membrane under the influence of air, especially with the laparotomy method of access, burns using an electric and radio wave knife, laser radiation, plasma scalpel, electrocoagulation and other methods of coagulation of small bleeding vessels, rinsing with hot solutions;
aseptic inflammatory process in the abdominal cavity under the influence of previous factors, as well as intraperitoneal hematomas and minor hemorrhages, treatment of the peritoneum with alcohol or iodine, the use of various other concentrated solutions (antiseptics, antibiotics) for washing the abdominal cavity;
the use of long-term absorbable suture material, the presence of drainage in the abdominal cavity, talc from gloves, gauze or cotton pieces, etc.;
oxygen deficiency of tissues and disturbances of metabolic processes in them, as well as inappropriate temperature conditions of the gas when using CO 2 -pneumoperitoneum for carrying out;
postoperative infection, which occurs more often with laparotomic access than with laparoscopic.

All of these factors, and most often their combination, are a trigger that leads to inflammatory processes, which are the cause of excessive biological synthesis of connective tissue, that is, the formation of adhesions. In operative gynecology, the maximum impact of the first three factors occurs during the procedure, and therefore the prevention of adhesions after removal of the uterus is of greatest importance compared to other gynecological operations.

In obstetrics, delivery by birth is somewhat less associated with mechanical and physical damage to the pelvic organs. However, frequently occurring surgical blood loss causes tissue hypoxia, disruption of their metabolism and the body's immune response, which also contributes to the development of adhesions and adhesive disease in the immediate or late postoperative period. Therefore, prevention of adhesions after cesarean section should be carried out in the same way as with other surgical interventions.

Methods for preventing adhesive disease

Based on observations and taking into account the mechanisms of formation of the adhesive process, prevention of the formation of adhesions should be carried out already during the surgical intervention itself. It includes the following basic principles:

Reducing damage to the peritoneum due to careful treatment of tissues, reducing (if possible) the time of surgery, economical use of coagulation techniques and wound retractors. In addition, it is necessary to reduce the number of sutures and the application of clips, carefully stop bleeding without impairing blood circulation in the tissues, remove all necrotic tissue and blood accumulations, suppress infection with low-concentrated antibacterial and antiseptic solutions, moisturize tissues and wash the abdominal cavity, use suture material that does not cause immunological reaction, prevention of glove talc and cotton dust from gauze wipes and tampons getting into the abdominal cavity.
Reducing the severity of inflammatory processes through non-hormonal and hormonal anti-inflammatory drugs.
Reducing the degree of primary response to aseptic inflammation.
Suppression of the cascade of increased blood clotting, reduction in the activity of fibrin formation and activation of processes aimed at its dissolution.
The use of agents aimed at reducing the accumulation of elastin and collagen proteins, which subsequently leads to the development of fibroplastic processes (fibrinolytic enzymes).
The use of the hydroflotation method, which consists of introducing crystalloid solutions (Ringer-lactate solution) or dextrans (icodextrin, etc.) into the abdominal cavity together with heparin and a solution of glucocorticosteroids in order to separate the contacting surfaces, activate the fibrinolytic activity of peritoneal cells and suppress the coagulation cascade.
The use of barrier preparations (gels, biodegradable membranes, hyaluronic acid, polyethylene glycol, as well as the introduction of surfactant-like agents, etc.), fixed on contacting surfaces in the abdominal cavity and pelvis and leading to their mechanical separation.

Thus, the main mechanism of importance in preventing adhesions is to minimize the trauma of surgical intervention. Surgical methods of prevention can be supplemented by other means and methods, which in no case can replace the first. In this regard, prevention of adhesions during laparoscopy has significant advantages.

The main advantages of the laparoscopic method in operative gynecology as a method that helps reduce the formation of adhesions are:

minimal degree of traumatization of blood loss due to the absence of large incisions of the anterior abdominal wall in areas of abundant blood supply;
minimal access, helping to prevent the possibility of penetration of ambient air and foreign reactive materials into the abdominal cavity, as well as drying out of the serous surface with the destruction of the phospholipid layer;
the use of bipolar electrodes, which damage tissue significantly less than monopolar and ultrasonic electrodes, and prevent the formation of adhesions;
work on organs and tissues magnified by an optical camera using instruments at a remote distance, thereby significantly reducing the risk of mechanical injury to the mesothelial layer;
reduction of manipulations with distant organs and tissues;
no need to isolate individual zones and floors of the abdominal cavity, for example, the intestines, with surgical drapes;
more gentle and faster restoration of anatomical structures and peristaltic function of the intestine;
the positive effect of laparoscopy itself on the activity of the peritoneum in terms of fibrinolysis (dissolution of fibrin).

At the same time, according to statistics, about 30-50% of all cases of pelvic pain occur after fallopian tubes and other diagnostic laparoscopic procedures. This is mainly due to the fact that:

carbon dioxide introduced into the abdominal cavity to provide laparoscopic access causes spasm of the capillaries of the superficial peritoneal layers, which leads to hypoxia and disruption of metabolic processes in the mesothelial layer; adding 3 volume percent oxygen to carbon dioxide significantly reduces these phenomena;
gas is introduced into the abdominal cavity under pressure;
gas is dry.

Thus, laparoscopic gynecology only slightly reduces the frequency and prevalence of adhesions, abdominal-pelvic pain syndrome and the frequency of re-operations associated with adhesions. Laparoscopic methods are not a reason to abandon the basic principles of preventing the formation of adhesions. The choice of additional anti-adhesion agents depends on the extent of surgical trauma.

Prevention of adhesive disease in the postoperative period consists mainly of:

restoration of water and electrolyte balance in the body;
carrying out anti-inflammatory and anticoagulant therapy;
early activation of the patient;
restoration of intestinal function as quickly as possible.

The principles of preventing the formation of adhesions are the same for all types of surgical interventions. Their use should be comprehensive and in accordance with the volume and nature of the injury.

Adhesive disease is the appearance of adhesions after surgery (areas of fibrous tissue) formed between the mucous membrane of the inner wall of the abdominal lining (parietal peritoneum) and the loops of the small and large intestines or other organs of the abdominal cavity: gall bladder, liver, bladder, ovaries, uterus.

In normal condition, the organs of the abdominal cavity and their walls are covered with slippery peritoneum, which prevents them from sticking to each other. Adhesions appear after interventions in organ tissue. The symptoms of postoperative adhesions will depend on their number and location. Treatment of adhesions can only be done surgically.

How do adhesions hurt and the reasons for their appearance?

The most common cause of the formation of adhesions is surgery on the abdominal organs. Almost everyone Patients (about 95%) develop adhesive disease after surgical interventions on the abdominal organs.

Adhesions can thicken and increase in size over time, causing problems many years after surgery.

Reasons for the formation of adhesions during operations:

In rare cases caused by the process of inflammation, the appearance of which is not related to the operation.

These reasons include:

Performing radiation therapy to treat cancer.
Appendicitis.
Infectious diseases of the internal organs of the abdominal cavity.
Gynecological diseases, for example, adhesions after removal of the uterus.
Adhesions after laparoscopy.

In rare cases, adhesive disease appears for no apparent reason.

Mechanism of appearance of adhesions

Under normal conditions, the loops of the large and small intestines can move freely inside the abdominal cavity, sliding, relative to each other and to other adjacent organs. This sliding is created by the peritoneum and its thin lubricating film.

During damage to the tissues of the abdominal cavity, an inflammation process occurs, in the area of which connective fibrous tissue, from which seals are formed. With the development of adhesions, the intestines will no longer be able to move freely throughout the abdominal cavity, since its loops are connected to each other, to the abdominal wall or to other abdominal organs.

In areas where adhesions form, the intestines can twist around their axis, which disrupts the normal passage of food or blood supply. More often this occurs in the small intestine. Typically, the twisting is temporary, but in some cases it may not recover spontaneously.

Adhesions: Symptoms of appearance

Doctors associate the signs and symptoms of adhesive disease not with the adhesions themselves, but with the problems they cause. People note various complaints, based on where the adhesions appeared and the functioning of which organs they disrupted. Most often, adhesions do not cause any symptoms, as they are simply not detected.

With adhesive disease, abdominal pain appears as a result of tension on the nerves within the adhesions themselves or in the abdominal organs.

Symptoms of adhesions in the abdominal cavity:

Intestinal obstruction, which is caused by adhesions, may require emergency surgery. Intestinal adhesions can cause crampy wave-like pain in the abdomen, which can last for several seconds and worsens after eating, as it increases the activity of the digestive system.

After pain occurs, the patient may vomit, which alleviates his condition. The patient gradually bloating appears, a person can hear a slight rumbling in the intestines, accompanied by loose stools and flatulence, and the temperature also increases.

Intestinal adhesive obstruction can resolve on its own. But the patient needs to see a doctor when the pathology progresses and the following symptoms appear:

Constant and severe pain.
Severe distension of the intestines.
Disappearance of bowel movements and gases.
Disappearance of intestinal peristalsis sounds.
Severe increase in body temperature.
The abdomen increases in size.

Subsequent progression of adhesive disease can lead to rupture of the intestinal wall and contamination of the abdominal cavity with its contents.

Adhesions during hysterectomy

When the uterus is removed, the symptoms of the appearance of adhesions in the female body are varied, since it is quite complex surgery. In gynecology, postoperative female adhesions occur in most patients. The appearance of adhesions is caused by many factors:

The main symptoms of uterine adhesions are expressed in the form of disturbances in the processes of defecation and urination, pain in the lower abdomen, as well as disruptions in the functioning of the gastrointestinal tract. To minimize the risk of uterine adhesions, anticoagulants and antibiotics are prescribed. Physiotherapy and physical activity are also recommended.

Diagnosis

Adhesions cannot be detected using x-ray methods or ultrasound. Many of them are determined during surgery. But still, computed tomography, irrigoscopy and radiography of the abdominal cavity can help diagnose their formation.

How to treat adhesions?

Adhesions that do not cause complaints do not require any treatment. There are no conservative methods for treating adhesions.

Treatment of adhesive disease will depend on the degree of formation and location of adhesions and the causes of their occurrence. Often the patient is in no pain and the condition improves without surgery. Before this disease develops, doctors prescribe symptomatic treatment.

Surgical treatment

To get rid of adhesions, as a rule, two methods of surgical intervention are used: open surgery and laparoscopy.

Open surgery is an intervention in which a large incision is made in the abdominal wall. In this case, under direct visual control, the adhesions are separated using an electrocoagulator or scalpel.
Laparoscopy is an operation in which a surgeon inserts a camera into the abdominal cavity through a small incision in the abdominal wall. After identifying adhesions, they are separated using scissors or cauterization with electric current.

Most often, they try not to use repeated surgery, since this is characterized by the risk of new adhesions.

How to treat adhesions in a traditional way?

There are many different folk methods that are used for adhesive disease. But in researching them safety and effectiveness have not been studied, so you should consult your doctor before using these methods.

Castor oil

Relieves inflammation and pain, and with continued use can reduce scar tissue. It is necessary to wet several layers with castor oil wool or cotton fabric, place it on your stomach where it hurts. Wrap the fabric in cling film and secure it with something, tying it around the waist. Then apply a hot heating pad to this area. This heat allows castor oil to penetrate the skin. This bandage must be kept on for 2 hours and then removed. These compresses must be done every other day.

Healing herbs

For treatment, it is recommended to use calendula and comfrey; they can be used in combination with each other or separately.

Calendula and comfrey tea:

Two cups of water;
0.5 teaspoon of calendula flowers;
0.5 teaspoon of comfrey leaves.

Add herbs to boiled water. Let it sit for about 20 minutes and express. If necessary, add honey. Use every day.

Calendula and comfrey oil:

One cup of dried calendula flowers;
One cup of dried comfrey leaves;
Olive and castor oil.

Place the herbs into a jar. Using the same ratio of castor and olive oils, add them to the herbs. To the bottom of the multicooker lay the fabric and place a jar of oil and herbs on it. Pour water into the multicooker bowl until it just barely reaches the top of the jar. Set to keep warm mode and keep the jar for five days. Every day you need to add a little water to the multicooker. After five days, drain the oil.

Gently rub this oil into your stomach twice a day. This must be done regularly, over several weeks. We must remember that before using any traditional medicine, you should consult your doctor.

Diet

Doctors were unable to identify a connection between nutrition and the prevention or development of adhesive disease of internal organs. But patients with partial intestinal obstruction will benefit from a slag-free diet.

This diet for adhesive disease limits the consumption of foods that contain high amount of fiber and other substances, poorly absorbed by the digestive tract. Although this daily menu does not closely meet the long-term needs of the patient's body, it can relieve abdominal pain and reduce the volume of stool during partial intestinal obstruction.

During the adhesive process, brown rice, whole grains, juices with pulp, fruits and vegetables, and dried beans are removed from the diet. The patient can eat jellies, creamy soups, yogurt, ice cream, and puddings, but they should not contain pulp or seeds.

The doctor may also allow you to consume baked goods made from refined flour, refined white rice, crackers, low-fat broths and soups, cereals, fish, tender poultry. Also, a slag-free diet for adhesive disease can limit fermented milk products.

Disease prevention

The appearance of adhesions in the abdominal cavity is difficult to prevent, but it is quite possible to minimize the risk of their formation.

Laparoscopic methods of performing surgical interventions reduce the risk of their formation, since they are done through several small incisions. When is the execution minimally invasive surgery for some reason is impossible, and a significant incision of the abdominal wall is required, then after the operation is completed, a solution or special film can be used that reduces the risk of adhesions.

Other methods that can be used during surgery to minimize the possibility of adhesions:

Careful touching of organs and tissues.
Use of gloves without talc and latex.
Using saline solution to hydrate organs and tissues.
Use of wet wipes and tampons.
Reducing the duration of surgical intervention.

The appearance of adhesions after surgical interventions on the abdominal organs is a fairly common occurrence. Most often, this does not cause any symptoms and is not life-threatening for the patient. But in some cases adhesive disease may cause a vivid symptomatic picture of intestinal obstruction, the elimination of which requires surgical intervention.

Arthur 03/15/2018

Hello. Is there a high probability of the formation of adhesions after an inguinal hernia operation using the Lichtenstein method (mesh)? Can we say that in 95% of cases adhesions appear? Thank you.

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