What adhesions look like after surgery. Spikes - what is it? Causes, symptoms and treatment of adhesions. Adhesions after abdominal surgery

Many people had to undergo various operations. However, not everyone knows what adhesions are after surgery.

Postoperative adhesions are formations of connective tissue in the abdominal or pelvic area that connect internal organs. Act as protection and limit the source of inflammation. Adhesions after surgery lead to disruption of the functioning of internal organs.

In normal condition, the internal organs are covered with a slippery membrane, which prevents them from sticking to each other. The adhesion appears after surgery. Clinical manifestations depend on the number and location of adhesions. Treatment can only be done surgically.

Adhesions form after surgery as a response to an inflammatory reaction. They connect adjacent organs or intestinal loops.

The main reasons for the appearance of strands are:

• surgical interventions;
• inflammation of the appendix and appendectomy;
• abortion;
• hemorrhage into the abdominal cavity;
• endometriosis;
• inflammatory diseases.

The main cause is surgery, but there are other risk factors:

1. Abdominal bruises. As a result, hemorrhage may occur.
2. Abdominal obesity. Excess adipose tissue forms the greater omentum, which closes the intestinal loops. The loose tissue of the omentum is especially sensitive to the appearance of strands.
3. Congenital anomalies of the abdominal organs.
4. Ingress of chemicals. This usually happens at the time of surgery, particles of gauze, iodine or other chemicals get inside. This may also cause adhesions to appear after surgery.

Postoperative adhesions are also formed due to the ingress of foreign objects.

Why are adhesions dangerous?

Normally, the organs in the abdominal and pelvic region are mobile. Intestinal loops can move during the digestion process. During pregnancy, an enlarging uterus does not have a negative effect on the bladder.

The resulting scars impair the mobility of internal organs. Adhesive disease is dangerous due to the development of intestinal obstruction. For women, this can lead to infertility. In some cases, adhesions may not cause discomfort to the patient. However, most often the patient is concerned about pain.

Clinical picture

The duration of formation of adhesions depends on the affected organ. Usually the patient is concerned about pain in the area of ​​the surgical scar.

The most common symptoms are:

• nausea, vomiting;
• diarrhea or constipation;
• pain on palpation in the suture area;
• increased body temperature;
• dyspnea;
• hyperemia in the scar area.

At first there are no symptoms. However, as the process progresses, nagging pain appears. In some cases, pain occurs when taking a deep breath. If adhesions develop in the pelvic area, then a woman may experience pain during sexual intercourse.

Very often, an adhesive process appears between neighboring organs. A cause for concern is paroxysmal pain that is not relieved by taking antispasmodic drugs. After some time, after the symptoms appear, the person becomes irritable. Officially, there are three forms of pathology:

1. Acute form - characterized by severe pain. Shortness of breath increases, body temperature rises. When you try to palpate the area, a sharp pain appears. Leads to acute intestinal obstruction and renal failure.
2. Chronic form - if the pathology appears in the pelvic area, then the symptoms are similar to premenstrual syndrome. Bowel and bladder dysfunction may occur. Pain syndrome appears when changing body position and sexual contact.
3. Intermittent form - characterized by symptoms in the gastrointestinal tract. Constipation gives way to diarrhea and vice versa.

In addition to pain, headaches and general malaise appear.

Diagnostic methods

If symptoms appear, the patient should consult a specialist. First, an examination and history taking of the patient is performed. Diagnosis of the disease must be comprehensive.

Analyzes

First of all, the patient needs to get tested.

1. A general blood test is prescribed for any disease. The analysis can show the presence of inflammatory processes, as well as the general condition of the body. With adhesive disease, there is leukocytosis, which indicates an inflammatory process in the body. There is also anemia.
2. Biochemical blood test - can tell about the functioning of internal organs, especially the liver and kidneys. There are abnormalities: elevated urea levels, low hemoglobin levels and C-reactive protein (in acute inflammation).

If intestinal obstruction is suspected, a stool test may be required. Additional tests may include a blood test for hormones and a semen analysis.

Instrumental diagnostic methods

The main diagnostic methods are instrumental studies. They are more informative than analyses. If adhesions are suspected after surgery, the following studies are prescribed:

• Ultrasound - the study shows the presence of adhesions;
• CT is the most informative method;
• radiography with a contrast agent - before the procedure you need to drink a special solution, which, when photographed, shows disturbances in the intestines and other complications;
• laparoscopy – a small incision is made in the abdomen and then a tube with a camera and light is placed. This allows diagnostics to be carried out from the inside.

After conducting instrumental diagnostics, the doctor may prescribe treatment or refer you for additional examination.

Differential diagnosis

Adhesive disease can be easily confused with diseases of the internal organs, since many clinical symptoms are similar. You need to know how to distinguish adhesions from another disease:

• pinched hernia - characterized by protrusion, pain and tension in the affected area;
• acute pancreatitis and cholecystitis - uncontrollable nausea and vomiting, increased body temperature, girdling pain;
• peptic ulcer of the gastrointestinal tract - paroxysmal pain in the abdominal area;
• acute appendicitis - pain in the right iliac region. High body temperature and increased leukocytes in the blood;
• torsion of an ovarian cyst - paroxysmal pain in the lower abdomen.

This diagnosis is carried out if the presence of adhesions is suspected. Diagnosis must be comprehensive and after clarification of the diagnosis, treatment is prescribed.

Treatment

You need to know how to treat adhesions after surgery. If they have just begun to form, they can be easily eliminated with timely treatment. Over time, the adhesions become rougher and more like scars or welts.

Surgery

In chronic forms of adhesive disease, surgical intervention is necessary. Under general anesthesia, adhesions are removed.

1. Laparotomy (operation through an incision in the abdominal wall) and laparoscopy (operation through punctures).
2. Excision of adhesions using a laser or electric knife.

During surgery, adhesions are eliminated, but this does not guarantee the elimination of relapses. The more surgical operations are performed, the higher the likelihood of developing adhesive disease.

Drug treatment

In the early stages, medications may be used. Enzyme therapy is carried out to introduce split enzymes into the body and is administered intramuscularly. Anti-inflammatory ointments are well suited for topical use.

Physiotherapy

Physiotherapy is especially effective for adhesions in the pelvic area. The following procedures are carried out:

• ozokerite and paraffin applications;
• electrophoresis with painkillers;
• laser therapy;
• magnetic therapy;
• ultrasound treatment;
• massage;
• hirudotherapy.

Physiotherapy can also be used in advanced stages of the disease. They help eliminate the inflammatory process and pain.

Prevention

To avoid the development of adhesions, the patient must follow the recommendations that the doctor gave after the operation. A couple of days after the operation, the patient needs to restore motor activity. Even minor movements act like a massage on the internal organs, which prevents them from sticking together. A combination of physical activity and special massage will help avoid the formation of adhesions after surgery. It’s easier to carry out prevention so that you can then wonder how to remove adhesions after surgery.

What happens to our body during operations? First, the tissues are cut, then connected, and they are forced to grow together again. It is believed that laparoscopic surgery, which is performed through several small incisions (“punctures”), is much less traumatic, since the surface of the surgical field is significantly smaller than with a conventional strip “open” operation.

During laparoscopy, damage occurs on the thin membrane covering the inner surface of the abdominal wall where instruments, incisions, or clips are inserted. After removing the instrument, this area of ​​the damaged membrane (called serosa) heals on its own.

How adhesions and scars form

However, our fabrics have one natural, irrevocable property - they strive to protect our body. And sometimes the development of so-called protective factors after damage occurs intensively - with a reserve.

What is Treatment of adhesions after surgery?

In practice, it looks like this: in places where the serous membrane is damaged, collagen and elastic fibers and connective tissue cells are intensively produced. If at this time any internal organ (for example, a loop of intestine) touches the area of ​​​​the damaged serosa, it is involuntarily involved in this process. A cord of connective tissue is formed, which leads from the wall of the internal organs to the inner surface of the abdominal wall. This is called adhesions.

Adhesions can also connect internal organs to each other. Each of them is also covered by a serous membrane. During the operation, micro-tears are not excluded. And these places of microtrauma can also subsequently become a source of the formation of adhesions between this organ and the organs adjacent to it.

Also, at the site of contact and healing of tissues after their dissection or rupture, a scar may form, in which the normal tissue is replaced by a more rigid and inelastic connective tissue. Scars can be on the skin, or they can be on internal organs.

Why are adhesions bad?

Nature made sure that in our harmonious body the organs were equipped and arranged clearly and correctly, like in Tetris. They occupy the entire internal space and touch each other with suitable sides, like a carefully fitted puzzle. If you consider all the organs separately from the body, you will be amazed at how much space they take up and how they fit inside us! It is precisely because postoperative scars and adhesions disrupt this initial harmony that they affect our body.

What is the negative impact of adhesions? They:

• interfere with the mobility of the organ, which affects its function. Moreover, both external mobility, which depends on the movements of the diaphragm, suffers, as well as internal mobility, which is active and does not depend on the movement of the diaphragm;
• disrupt blood circulation in the affected organ;
• disrupt the innervation of the organ;
• contribute to the occurrence of pain and spasms in the organ.

Sometimes the adhesion is so powerful that it can disrupt the anatomically correct position of the organ. All of the above reasons lead to other disorders in the body. And yet, which at first glance are not related to the affected area. Adhesions and scars that arise after abdominal surgery can cause pain in various parts of the spine, joints, lead to changes in posture and disruption of the body’s position in space, etc.

How are adhesions treated?

According to the timing of formation of adhesions, they are distinguished:

• 7-14 days after surgery – the phase of young adhesions, when the adhesions are still very loose and easily torn;
• 14-30 days after surgery is the phase of mature adhesions, when the adhesions thicken and become strong.

Starting from the 30th day after the operation and further, for several years, the process of restructuring and formation of scars and adhesions occurs. The process is individual, much depends on the properties of the body itself, its anatomical structure, and the functioning of internal organs.

The doctor may suspect the presence of adhesions in the abdominal cavity based on clinical data, medical history, and the results of studies such as ultrasound, CT, and colonoscopy. Adhesions in the abdominal cavity and pelvic cavity can be treated with medication or surgery. During surgery, the adhesions are separated, but this method should be used only in extreme cases, if the cords are so thick and rough that they severely disrupt the function of the organ, and more loyal and gentle treatment does not help.

How osteopathy affects adhesions

An osteopathic doctor is able to feel with his hands where the adhesions are located and where they lead, where they are attached and what they are pinching. He is also able to loosen their tension in a few sessions, and can restore, balance and balance damaged organs, and therefore restore their function to the fullest possible extent.

An osteopathic doctor is also able to interrupt the chains of damage and pain in parts of the body that seem to be unrelated to the operated area. After all, our body is an integral system where everything is interconnected. The osteopath acts on the adhesion directly, without violating the integrity of the body tissues, and therefore without an additional factor stimulating the formation of connective tissue. By restoring and harmonizing the function of the suffering organ, the body releases energy to initiate complete recovery in possible individual conditions for the entire organism.

Any surgical intervention, no matter how minimally gentle it may be, leaves behind a lot of negative changes, injuries and stress, which the body is forced to fight alone. What the body will do to heal itself, what it will sacrifice, how it will limit itself is always individual. But within the framework of self-preservation, this is always expressed in loss of function to one degree or another, and therefore subsequent suffering of the entire organism with loss of compensation and the expenditure of much greater effort on normal functioning throughout life.

Therefore, if you have had surgical interventions on the abdominal organs in your life, consult an osteopathic doctor. It does not matter whether the operation was conventional or performed using a gentle laparoscopic method. Any discomfort has a reason, which means there is an opportunity to solve it.

An osteopathic doctor can use pulse diagnostics to determine the significance of adhesions or scars on the body. This means that if, when pressing on a postoperative scar, the properties of your pulse change, then this zone is important and significant for the whole organism, and this adhesion or scar must be worked with.

Adhesions and scars have the following significance and prevalence of influence:

• local (the effect is limited to the area where the scar or adhesions are located);
• regional (the effect extends to the entire thoracic or abdominal region where the commissure is located);
• global (affects the entire body, even to the point of disturbing its position in space).

How long does osteopathic treatment last?

If the patient has undergone surgery, then the osteopathic doctor will tactically act as follows. 10 days after the operation, when the stitches are removed, the doctor will work with the scar itself layer by layer, work with the tissues directly around the scar itself and restore that independent mobility of the organ, which does not depend on the movement of the diaphragm. This period of work ranges from 10 days to 3 months after the operation.

If the duration after surgery is 3 or more months, then the doctor will pay attention to all surrounding organs and tissues in the operation area, influence the mobility of all internal organs in general and directly to the localization of the adhesions themselves.

The information was prepared by a leading specialist at the osteopathy and family medicine clinic Osteo Poly Clinic, osteopathic physician, chiropractor, and endoscopist surgeon.

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.

1. The most common is supravaginal removal or amputation.
2. Extirpation of the uterine body with appendages involves amputation of both the cervix and both ovaries.
3. 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:

1. laparoscopy;
2. 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.

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Thin films of connective tissue between internal organs are adhesions. They occur most often after surgery. Let's consider the features of their appearance and treatment.

Human internal organs are externally covered with a thin membrane that separates them from each other. A small amount of fluid and the smoothness of the tissues ensure the displacement of organs during movements.

Normally, after the operation, the internal organ is scarred, and the period of its healing is called the adhesive process. That is, connective tissue adhesions (similar to plastic film or fibrous strips) are physiology that go away on their own and do not disrupt the functioning of the body.

As the pathological process develops, the strands stick together, disrupting the normal movement and functioning of organs. After surgery, they are most often diagnosed on the following organs:

• The appendix and intestinal lesions lead to obstruction of the organ and require additional surgical treatment.
• Formations in the pelvis can significantly impair women’s health and the possibility of conceiving a child.
• Inclusions in the ovaries or tubes - occur due to inflammation of the appendages or infectious lesions and can lead to infertility.
• Without timely diagnosis and treatment, this can lead to serious complications and severe pain.

Why are adhesions dangerous after surgery?

Very often, patients wonder why adhesions are dangerous after surgery. So, if cords appear in the abdominal cavity, for example, in the small intestine, then this negatively affects the functioning of the digestive system. Such neoplasms complicate any surgical interventions in the abdominal cavity, significantly increasing the risk of organ perforation and bleeding.

Connective tissue inclusions in the peritoneum are dangerous because they can cause intestinal obstruction and intestinal obstruction. Neoplasms bend and stretch certain parts of the intestines or organs, disrupting their functioning. In this case, a life-threatening condition is complete intestinal obstruction.

The proliferation of connective tissue on the respiratory organs causes respiratory and cardiovascular failure. Due to disruption of the local blood supply, tissue necrosis and the development of peritonitis are possible. Formations on the pelvic organs are quite dangerous. Thus, adhesions of the ovary, uterus or intestines can cause obstruction of the fallopian tubes and infertility.

ICD-10 code

K66.0 Peritoneal adhesions

Epidemiology

According to medical statistics, the epidemiology of adhesions in 98% of cases is associated with surgical intervention. Adhesive disease affects women more often (after appendectomy and operations on the uterus and appendages) than men (abdominal injuries).

• After surgery on the abdominal organs, fusions appear in the small and large intestines in 80-85% of patients.
• Repeated laparotomy leads to the formation of adhesions in 93-96% of patients.
• After appendicitis, intestinal adhesions appear in 23% of those operated on after a year and in 57% after three years.
• After gynecological pathologies, in 70% of cases, cords appear on the uterus and ovaries.

The formation of collagen fibers begins on the third day of the pathological process, and connective tissue adhesions appear from 7 to 21 days. During this time, loose cords are transformed into dense scar tissue, blood vessels and even nerve endings appear in them.

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Causes of adhesions after surgery

There are a number of factors that influence the growth of connective tissue of internal organs. The reasons for the formation of adhesions after surgery largely depend on the professionalism of the surgeon. Most often, the pathological condition occurs when:

• Inflammatory and infectious complications.
• Bleeding in the abdominal cavity.
• Injuries of the abdomen and pelvic organs.
• Prolonged tissue ischemia.
• Foreign objects in the wound.
• Violations of surgical technique.

The adhesive process can also be provoked by the patient himself, due to failure to follow the doctor’s recommendations for recovery after surgery. Strands form after appendicitis, ectopic pregnancy or abortion, with intestinal obstruction, endometriosis and gastric ulcers.

Based on this, we can conclude that postoperative inclusions are formed for many reasons. Without timely diagnosis and treatment, they impede the functioning of internal organs, which leads to various complications.

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Risk factors

The proliferation of connective tissues of internal organs is in most cases associated with surgery, but there are other risk factors. The pathological condition is possible when:

1. Strands in the abdominal cavity can form due to bruises and injuries to the abdomen. Hemorrhages in the retroperitoneal space and hematomas in the mesentery lead to lymphostasis and impaired blood outflow. In turn, this leads to impaired exudation into the abdominal cavity. As a result, the internal organs are left without natural lubrication and begin to rub against each other and become soldered together.
2. Abdominal obesity - excess adipose tissue in the area of ​​the enormous omentum, that is, the folds behind the visceral sheet of the peritoneum and the closing loop of intestine, can provoke connective tissue adhesions. The loose tissue of the omentum is especially sensitive to the formation of bands due to the pressure of fatty deposits in the abdominal area.
3. Adhesions can occur during inflammatory processes. For example, in chronic cholecystitis, adhesions appear not only on the gallbladder, but also on the liver, stomach, duodenum, and omentum. Most often, this is observed after influenza, dysentery or Botkin's disease.
4. Another risk factor is congenital malformations of the abdominal organs. As a rule, adhesions are diagnosed in the area of ​​the ileum and cecum.
5. Some chemicals promote the formation of strands. For example, alcohol, Ravinol and iodine lead to aseptic inflammation of the abdominal cavity. Most often, these fluids enter the peritoneum during surgery.

In addition to the above factors, there is a huge risk of adhesions after laparotomy. Any operation on the abdominal organs is associated with mechanical trauma to the peritoneum. Moreover, the more roughly the surgeon works, the higher the risk of pathological fusions. The disorder occurs due to a violation of the body's fibrinolytic system.

Pathogenesis

The mechanism of development of cords of internal organs is associated with cellular and humoral processes. The pathogenesis of adhesions after surgery is based on a violation of the local balance between the synthesis of fibrin and fibinolysis, that is, its breakdown. Surgical interventions lead to damage to the mesothelial layer of tissue and blood vessels. This results in an inflammatory response and activation of inflammatory mediators and the formation of blood clots.

The permeability of blood vessels gradually increases, and damaged tissues secrete serous-hemorrhagic exudate (contains leukocytes, platelets, interleukins, macrophages, fibrinogen, hyaluronic acid, proteoglycans). Under normal conditions, fibrin undergoes lysis, but due to surgery, fibrinolytic activity is reduced, and excess fibrinogen is transformed into a kind of gel that covers the affected tissue. Gradually, fibroblasts grow and adhere to each other, transforming into internal scars, that is, adhesions.

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Symptoms of adhesions after surgery

The duration of formation of connective tissue adhesions directly depends on the affected organ. Symptoms of adhesions after surgery most often manifest themselves as pain in the area of ​​the surgical scar.

The most common symptoms of post-operative distress are:

• Nausea and vomiting.
• Defecation disorder.
• Lack of stool.
• Regular constipation.
• Painful sensations when palpating the surgical suture.
• Increased body temperature.
• Difficulty breathing and shortness of breath.
• Redness and swelling of the outer scar.

Initially, there are no pain symptoms, but as the scar thickens, they become painful. Discomfort increases with physical activity and any movement. For example, after surgery on the liver, lungs or pericardium, pain occurs when taking a deep breath. If adhesions form on the pelvic organs, then pain during sexual intercourse is possible. The clinical picture depends on the location of the strands and the general condition of the body.

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First signs

Very often, after surgery, patients are faced with a problem such as connective tissue adhesions between adjacent organs or surfaces. The first signs of the adhesive process are manifested by cramping pain in the scar area. The discomfort is aching in nature and increases with physical stress.

The pathological condition is accompanied by attacks of nausea and vomiting. Possible bloating and frequent constipation. Paroxysmal pain subsides and returns. Because of this, the patient becomes irritable, and changes in body weight are possible due to lack of appetite. As the disease progresses, disorders of the cardiovascular and respiratory systems appear.

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Pain with adhesions after surgery

Symptoms such as pain with adhesions after surgery occur in many patients. The discomfort is paroxysmal and cutting in nature. At the same time, taking antispasmodics and painkillers does not give positive dynamics.

Depending on the pain, the following forms of adhesions are distinguished:

1. Acute form - adhesions cause pain of varying intensity, which leads to a sharp deterioration in well-being. The temperature rises, shortness of breath appears, and the pulse quickens. Attempts to palpate a postoperative scar cause severe pain. Against this background, intestinal obstruction and renal failure may develop.
2. Chronic form - if cords have formed in the pelvis, then the symptoms of the disease are similar to premenstrual syndrome. Possible disturbances in the functioning of the intestines and bladder. Pain appears during sexual intercourse and when changing body position.
3. Intermittent form - characterized by severe disturbances in the functioning of the gastrointestinal tract. Chronic constipation gives way to indigestion. Pain occurs less frequently, but is quite intense.

In addition to pain, there are frequent attacks of nausea and vomiting, loss of appetite, possible loss of performance, migraines and dizziness.

Intestinal adhesions after surgery

Formations of connective tissue between the intestinal loops and abdominal organs are intestinal adhesions. After surgery they appear most often. Surgical intervention leads to gluing of the serous membranes of organs to each other and to their functional disorders. In this case, the cords consist of the same tissue as the outer wall of the intestine.

Consider the main reasons for the appearance of connective tissue adhesions of the intestine:

1. Surgical intervention - according to medical statistics, if a primary laparotomy intervention was performed on the intestine, inclusions form in 14% of patients. If this is the 3rd or 4th operation, then soldering occurs in 96% of cases. The pathology is aggravated by infectious and inflammatory processes.
2. Abdominal injuries (open, closed) - very often mechanical damage leads to internal bleeding. Hematomas form on the intestines, lymphatic outflow and metabolic processes in the tissues of the organ are disrupted. Inflammation develops, which provokes an adhesive process.

In addition to the reasons described above, the disorder can occur due to inflammation of the appendages in women, congenital anomalies in the development of the organ, foreign bodies in the peritoneum, or taking certain medications.

There are additional risk factors for adhesions after intestinal surgery:

• Ischemia of organ tissue.
• Application of non-absorbable sutures.
• Postoperative infections.
• Intraoperative trauma.
• Blood in the peritoneum after surgery.
• Hereditary predisposition to the formation of cords.
• Hyperactivity of connective tissue.
• Decreased local immunity.

Symptoms of the pathological condition are divided into several stages. The first thing the patient encounters is intestinal obstruction. Paroxysmal pain in the abdominal area occurs, which is accompanied by nausea and profuse vomiting. Possible asymmetrical bloating. Palpation of the abdominal cavity causes severe pain. Early adhesive obstruction, as a rule, forms against the background of an inflammatory process. If this condition is left without medical attention, it will lead to intoxication complications and organ paresis.

Diagnosis of postoperative intestinal pathologies is based on characteristic symptoms, visual examination of the patient and medical history. To clarify the diagnosis, plain radiography of the abdominal cavity, electrogastroenterography, ultrasound and MRI, and laparoscopy are used. During research, it is necessary to differentiate cords from other types of acute intestinal obstruction or tumor formations. Treatment is surgical, with a course of physiotherapy to prevent the proliferation of connective tissue.

Adhesions after abdominal surgery

Almost every patient encounters such a pathology as adhesions after abdominal surgery. The proliferation of connective tissue can lead to adhesive disease, which is accompanied by serious disruptions in the functioning of internal organs.

The adhesive process with a large incision in the abdominal wall, that is, after laparotomy, can occur for the following reasons:

• Inflammatory reactions.
• Infectious complications of surgery.
• Anti-blood clotting.
• Increased protein content in the blood.
• Individual characteristics of the body.

If, during trauma to the peritoneum, only one layer of it is damaged, and the one with which the internal organs are in contact is intact, then adhesions, as a rule, do not form. If adhesions do appear, this does not lead to disruption of organ function, since the strands are superficial and easily delaminate.

If two contacting leaves were injured, this triggers a number of pathological reactions. Violation of the integrity of blood capillaries is associated with certain blood proteins, and the adhesion of organs with coagulation factors and the action of globulins.

Connective tissue adhesions are small in size, but can lead to deformation of the organ structure. Clinical signs of the disease depend on the location and size of the adhesions. Most often, patients encounter the following problems: abdominal pain, deterioration in general health, constipation, nausea and vomiting. Painful sensations arise due to dysfunction of the intestines, and, as a rule, they are paroxysmal in nature. To diagnose the disease, anamnesis is collected and the patient is examined. Treatment is surgical.

Adhesions after hysterectomy surgery

Seals from connective tissue that occur during surgical interventions and inflammatory processes are adhesions. After surgery to remove the uterus, they occur in 90% of women. Strands are a rather dangerous complication, as they can lead to functional disorders in the functioning of internal organs and even severe intestinal obstruction.

Hysterectomy, that is, removal of the uterus, is characterized by the formation of connective tissue scars at the site of incisions and scars. If the physiological process occurs with complications (infection, inflammation), then the fibrous strands continue to grow and grow into other internal organs.

The main reasons for the proliferation of connective tissue after removal of the uterus depend on the following factors:

• Duration of the operation.
• Scope of surgical intervention.
• Volume of blood loss.
• Endometriosis.
• Genetic predisposition to adhesive disease.
• Internal bleeding and wound infection in the postoperative period.
• Immune system disorders.

In addition to the above factors, the development of pathology largely depends on the actions of the surgeon. In some cases, the disorder occurs due to foreign objects in the abdominal cavity, for example, if fibers from a tampon or gauze, or particles of talc from the surgeon’s gloves get into the wound.

Signs of the development of a pathological process are manifested by the following symptoms:

• Drawing and aching pain in the lower abdomen. The discomfort is periodic.
• Disorders of urination and defecation.
• Dyspeptic disorders.
• A sharp increase in temperature.
• Painful sensations during sexual intercourse.

If more than a month has passed since your hysterectomy and the above symptoms do not go away, you should immediately seek medical help. To diagnose the disorder in the postoperative period, I prescribe the following examinations to the patient:

• Complex of laboratory tests.
• Ultrasound examination of the abdominal cavity and pelvic organs.
• X-ray of the intestine using contrast.
• Laparoscopic diagnosis.

Connective tissue adhesions are treated surgically. Dissection and removal of tumors is carried out using laser therapy, aquadissection, and electrosurgery. In the postoperative period, drug prophylaxis is indicated. The patient is prescribed broad-spectrum antibiotics and anticoagulants. Physiotherapy with electrophoresis of enzymes that destroy fibrin is also prescribed.

If adhesions in the uterus are left untreated, this will lead to the fallopian tube turning into a connective tissue sac. The organ will lose the ability to promote fertilized eggs. In this case, even surgical treatment is not able to restore the functions of the fallopian tubes, which is one of the causes of infertility.

Adhesions after appendicitis surgery

One common surgical procedure is removal of the appendix. Despite the simplicity of the procedure, the patient faces a long recovery period. Adhesions after appendicitis surgery form quite often and are one of the complications.

The proliferation of connective tissue is associated with irritation of internal organs due to mechanical stress on them. Dense cords gradually form on the membranes that cover the intestines. They grow among the internal organs, occupying a certain space. The pathological process is accompanied by damage to the blood vessels and leads to intestinal deformation due to the fusion of its loops with each other.

The appearance of cords after treatment of appendicitis is associated with the following factors:

• Removing the appendix using an open method rather than laparoscopy.
• Protracted inflammatory process after surgery (peritoneal and intestinal tissues are affected by pathogens and their toxins).
• Genetic predisposition to increased activity of certain enzymes that accelerate the scarring process.
• Development of pathology due to medical error (for example, a napkin left in the abdominal cavity).
• Coagulation (when blood vessels are cauterized, strands can form) or internal bleeding.

The painful condition manifests itself as nagging pain in the area of ​​the postoperative scar and deeper in the abdomen. Against this background, gastrointestinal symptoms arise: bloating, nausea and vomiting. There is also a decrease in blood pressure and cardiac dysfunction, general weakness. To diagnose connective tissue adhesions, ultrasound examination of the abdominal cavity, medical history, a set of laboratory tests, radiography and diagnostic laparoscopy are indicated.

Treatment depends on the diagnostic results. The patient is prescribed conservative therapy, which consists of taking medications, following a therapeutic diet and physiotherapy. In especially severe cases, surgical treatment is prescribed. The operation is performed using a laser or electric knife. The doctor dissects the adhesive formations, freeing the organs.

Leaving appendicitis without medical attention can lead to serious complications. First of all, this is intestinal obstruction due to compression of the organ loops. If the appendages, uterus or fallopian tubes are affected, infertility may develop. The most dangerous complication is tissue necrosis. Adhesions put pressure on tissues and compress blood vessels, which leads to poor circulation. The bleeding area gradually dies.

Adhesions in the nose after surgery

Synechiae or adhesions in the nose after surgery are connective tissue cartilaginous or bone bridges between the mucous walls of the nasal sinuses. In addition to surgical intervention, neoplasms can appear for the following reasons:

• Disorders of intrauterine development and genetic pathologies.
• Chemical or thermal burns of the mucous membrane.
• Infectious diseases.
• Regular nosebleeds.
• Syphilis.
• Scleroma.

In some patients, the bands do not cause discomfort because they are soft and thin. But most often patients face the following problems:

• Difficulty in nasal breathing.
• Voice change.
• Dry throat in the morning.
• Full or partial perception of odors.
• Inflammation of the upper respiratory tract.
• Inflammation in the paranasal sinuses.

Synechiae in the nasal cavity are distinguished depending on their location and the tissue from which they are formed. If the growths formed in the vestibule of the nose, then they are anterior, the inclusions between the nasal concha and the septum are median, and the formations in the choanae are posterior synechiae. The last type of splice is the most dangerous, since they can completely or partially block the air supply from the nose to the pharynx.

There are also connective tissue cords that have a soft texture and are easy to dissect. More dense and osseous neoplasms are most often a sign of congenital pathology and require surgical treatment. To diagnose postoperative adhesions in the nose, you should consult an otolaryngologist. Using rhinoscopy, the doctor determines the presence of pathology. It is also necessary to undergo a set of laboratory tests that will identify inflammatory processes and other disorders.

Treatment is carried out only surgically, since neoplasms do not resolve on their own. For this, a classic operation can be prescribed, that is, removal with a scalpel, laser removal or radio wave exposure. Drug therapy is used only to relieve an infectious or inflammatory process.

If the pathology is left untreated, it can lead to various ENT diseases (pharyngitis, otitis media, pneumonia, bronchitis). In addition, insufficient ventilation of the paranasal sinuses is an ideal environment for infection, which can affect the ears and affect the quality of hearing.

Adhesions in the pelvis after surgery

Connective tissue adhesions in the pelvic organs are a common pathology among women that leads to infertility. Adhesions in the pelvis after surgery occur due to tissue trauma and various inflammatory complications. Moreover, the longer and more traumatic the operation, the higher the risk of cord formation.

The clinical picture of the adhesive process has several forms:

• Acute – the pain syndrome has an increasing character. Nausea and vomiting, increased body temperature, and increased heart rate appear. When trying to palpate the abdomen, sharp pain occurs. Acute intestinal obstruction, general weakness and drowsiness, and urinary disorders are also possible.
• Intermittent form - periodic pain, there are intestinal disorders (diarrhea, followed by constipation).
• Chronic – the symptoms of this form are hidden. Aching pain in the lower abdomen, constipation. Most often, this type of disorder is diagnosed accidentally, during an examination for suspected infertility or endometriosis.

Diagnosis is difficult. When initially seeking medical help, the doctor collects the patient’s medical history and complaints. Bimanual examination reveals immobility of organs or their limited displacement. Ultrasound, MRI, laboratory tests and other examinations are also performed.

Treatment of cords after pelvic surgery consists of medicinal and surgical methods. To remove adhesions and separate organs, the following methods are used: laser therapy, aquadissection, electrosurgery. Conservative therapy is based on eliminating the inflammatory process. Patients are prescribed a therapeutic diet, physiotherapy and a set of other measures for normal recovery.

Adhesions after gallbladder surgery

The formation of cords during cholecystectomy occurs in every third patient. Adhesions after gallbladder surgery are associated with several factors, let’s consider them:

• Injuries and bruises of the peritoneum, which disrupt the outflow of blood from the tissues lining the surface of the abdominal cavity.
• Aseptic inflammation caused by the ingress of certain substances (alcohol, iodine or rivanol solution) into the peritoneum during surgery.
• Inflammatory infiltration in the surgical area.
• Chronic cholecystitis causes scarring of the gallbladder, which significantly complicates the process of its removal and recovery after surgery.
• Atypical anatomical structure of the organ, its vessels and bile ducts.

Risk factors for the occurrence of adhesions include the patient’s advanced age, excess body weight, and the presence of chronic diseases. The painful condition may be associated with blood or inflammatory fluid, which did not resolve after surgery, but thickened and was replaced by connective tissue.

Symptoms of cords after gall bladder surgery are manifested by decreased blood pressure, sharp acute pain, constipation, general weakness and increased temperature. If the pathology becomes chronic, then the following symptoms occur: intestinal spasms, bloating, vomiting with feces, severe thirst, deterioration in general well-being.

Treatment depends entirely on the physical condition of the patient and the course of the adhesive process. Anticoagulants, proteolytic enzymes, and fibrinolytics are indicated as drug therapy. In severe cases, surgery is performed. Particular attention is paid to prevention, which consists of a special diet and physiotherapy.

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Adhesions after ovarian surgery

There are a number of reasons why adhesions form after ovarian surgery. The main factor is a prolonged inflammatory process, infection or complications during surgery. Possible causes of the disorder include:

• Erosion of the cervix or disturbances during cauterization.
• Numerous ruptures sustained during childbirth.
• External endometriosis and blood entering the abdominal cavity.

The risk of postoperative fusions directly depends on the individual characteristics of the patient’s body and on compliance with medical recommendations after surgery. That is, abdominal injuries, various diseases of the pelvic organs, STDs, abortion, hypothermia and even long-term use of antibiotics can provoke the appearance of inclusions after ovarian surgery.

The pathological process goes through several stages in its development.

1. The strands are localized around the ovary, but do not disrupt the capture of the egg.
2. Tissue grows between the ovary and the fallopian tube, creating an obstacle to the egg.
3. The fallopian tube is torsioned, but its patency is not impaired.

The disorder is characterized by menstrual irregularities, nagging pain in the lower abdomen and lower back, discomfort during sexual intercourse, and the inability to become pregnant for a long period of time. Since the symptoms may coincide with signs of other gynecological or endocrine pathologies, you should consult a doctor and undergo a thorough diagnosis.

To treat connective tissue adhesions, the method of laparoscopy, laser therapy, electrosurgery or aquadissection technique is used, that is, dissection of neoplasms with water. The patient is prescribed a course of antibacterial therapy to suppress infection, anti-inflammatory and fibrinolytic agents, anticoagulants and vitamins.

Adhesions after spinal surgery

Scars and adhesions after spinal surgery occur in almost all patients. This leads to a narrowing of the spinal canal. At the site of the lesion, both an infectious and an autoimmune process can develop with disruption of the movement of cerebrospinal fluid. Fibrous cords fuse spinal roots with herniated intervertebral discs, epidural tissue and spinal cord membranes. New growths can be either light or heavy and dense.

The main causes of adhesions in the spine:

• Traumatic hematomas.
• Infectious complications.
• Epidural administration of certain medications.
• Removal of herniated intervertebral discs.

The painful condition begins with aseptic inflammation. Swelling occurs in the surgical area, which affects the spinal root and surrounding tissues. Gradually, the inflammatory process enters the fibroblastic stage, forming dense adhesions.

The cicatricial adhesion fixes the nerve root in one position, putting increased pressure on it. This provokes severe painful sensations of varying intensity. Chronic pain is disguised as various diseases of the spine. For example, cords in the lumbar region are similar in pain to lumbodynia. Discomfort can spread along the sciatic nerve to one or both legs. Without treatment, this condition leads to tissue malnutrition and atrophic processes.

Adhesions after lung surgery

A problem such as adhesions after lung surgery occurs in 30% of patients who have undergone surgery. Overgrown connective tissue cords are most often localized between the serous membranes of the pleural cavity. They can occupy all sections of the pleura (total) and single cavities due to fusion of the pleural layers. Strands form anywhere there is connective tissue.

The pathological condition has the following symptoms: shortness of breath, rapid heartbeat, respiratory failure, pain in the chest cavity, various respiratory disorders due to disruption of natural ventilation of the lungs. Deterioration in general health, cough, sputum production, elevated body temperature, oxygen starvation, intoxication.

Strands negatively affect the functioning of the respiratory organs, complicate their work and limit mobility. In some cases, the cavities become completely overgrown, which causes acute respiratory failure and requires urgent medical attention.

To diagnose the disease, fluorography and x-rays of the lungs are performed. Treatment depends on the severity of the disease state. Surgical intervention is indicated if tissue inclusions provoke pulmonary failure and other life-threatening conditions. In other cases, drug therapy and a course of physiotherapy are carried out.

Adhesions after gastric surgery

The abdominal organs are most susceptible to the appearance of postoperative cords. Neoplasms are localized between the intestinal loops, stomach and other organs, causing gradual fusion of the serous membranes.

Adhesions after gastric surgery can be aggravated by the following factors:

• Abdominal injuries (open, closed).
• Increased synthesis of enzymes that provoke the proliferation of connective tissue.
• Inflammatory and infectious diseases of internal organs.
• Radiation therapy for oncology.

According to medical statistics, fusions develop in 15% of patients after surgery. The clinical picture of the pathology is accompanied by the following symptoms: nagging pain, digestive disorders, intestinal obstruction, appetite disturbances, sudden weight loss, problems with stool. Treatment can be either conservative or surgical, depending on the severity of the pathology.

Complications and consequences

The adhesive process, like any pathology left untreated, can cause serious consequences and complications. Most often, patients encounter the following problems:

• Acute intestinal obstruction.
• Respiratory failure.
• Inflammatory and infectious pathologies.
• Obstruction of the fallopian tubes.
• Infertility.
• Peritonitis.
• Tissue necrosis.
• Bend of the uterus.
• Chronic pain.

Regardless of the severity of complications, the adhesive process requires surgical treatment and a set of preventive measures.

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Diagnosis of adhesions after surgery

If a postoperative adhesive process is suspected, the patient is prescribed a set of various examinations. Diagnosis of adhesions after surgery consists of:

• History taking and visual examination.
• Analysis of patient complaints.
• A set of laboratory tests (blood, urine).
• Instrumental diagnostics (ultrasound, MRI, CT, radiography, laparoscopy).

The results of a comprehensive medical examination make it possible to determine the presence of cords, their location, thickness and even shape. Assess the functioning of internal organs and identify existing disorders. Based on the results of the diagnosis, a treatment plan is drawn up.

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Analyzes

Laboratory diagnosis of the adhesive process is necessary to determine the degree of its impact on the body. Tests are usually ordered based on clinical symptoms. Most often, patients complain of pain of various localizations and disturbances in intestinal function.

To diagnose a painful condition, it is necessary to undergo the following tests:

1. A general blood test is a standard test that is prescribed to all patients, regardless of the suspected disease. Determines the general condition of the body and allows you to draw conclusions about the functioning of all its organs and systems. With adhesive disease, the following abnormalities may be present in the blood:

• Leukocytosis - an increased level of leukocytes indicates an inflammatory process. Moreover, the more rod cells, the more intense the inflammation.
• Anemia – a decrease in the number of red blood cells occurs when there is bleeding in the body. In postoperative cords, this is a rare deviation, which may be associated with increased physical activity and rupture of the adhesions. This condition requires treatment, as a low level of red blood cells reduces the protective properties of the immune system.

1. Biochemical blood test - reflects the functioning of internal organs, especially the liver and kidneys. In a pathological condition, the following violations are possible:

• Increased urea levels – occurs due to urinary retention. This is observed when the walls of the bladder or ureter are deformed by cords. Indicates the involvement of the urinary tract in the adhesive process.
• Reduced hemoglobin - found in red blood cells, so it may indicate internal bleeding.
• C-reactive protein - indicates the acute phase of inflammation.

A stool test may also be prescribed, which is performed if intestinal obstruction caused by adhesions is suspected. With concomitant infertility, a blood test for hormones and an analysis of seminal fluid are indicated, which will determine reproductive dysfunction and whether connective tissue adhesions are associated with this.

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Instrumental diagnostics

Another method for identifying adhesions is instrumental diagnostics. If adhesions are suspected after surgery, the patient should undergo the following examinations:

• Ultrasound – ultrasound examination of internal organs visually determines connective tissue adhesions.
• CT - computed tomography allows not only to study the pathological process, but also the factors that provoked it. Refers to the most effective diagnostic methods.
• X-ray with contrast agent - before the procedure, you must drink a glass of barium salt on an empty stomach. X-rays will show bowel abnormalities and other complications that cause pain.
• Laparoscopy – to carry out this diagnostic method, a small puncture is made in the abdominal cavity and a fiber-optic tube with a camera is inserted. The device fixes adhesions and allows you to cut them out.

Based on the results of instrumental diagnostics, the doctor can prescribe the necessary treatment or additional examinations.

Differential diagnosis

In terms of its symptoms, the adhesive process is similar to many diseases. Differential diagnosis makes it possible to identify connective tissue adhesions and separate them from other pathologies. Since postoperative pain syndrome and the presence of scars do not always indicate cords. At that time, adhesions can simulate kidney damage, peptic ulcer disease, respiratory failure, pancreatitis, cholecystitis, and lumbodynia.

Let's consider the differential diagnostic signs of abdominal adhesions and other diseases of the internal organs:

• A strangulated hernia is the presence of a hernial protrusion, pain and tension in the affected area.
• Acute pancreatitis or cholecystitis - intense pain in the right hypochondrium or encircling pain. Increased body temperature, severe nausea and vomiting.
• Ulcerative lesions of the stomach or duodenum are acute, paroxysmal pain in the abdomen that intensify with the slightest movement. Fluoroscopy reveals free gas in the peritoneum.
• Acute appendicitis - pain in the right iliac region, which intensifies with movement. Increased body temperature and increased levels of white blood cells.
• Torsion of an ovarian cyst - paroxysmal pain in the lower abdomen. When trying to palpate the abdomen, a voluminous neoplasm is determined.

The differentiation process is carried out at the first suspicion of postoperative adhesions. For this purpose, laboratory and instrumental diagnostic methods are used.

Treatment of adhesions after surgery

The method of treating adhesions after surgery depends on the general condition of the patient. Since the main cause of the formation of cords is surgical intervention, treatment should be as gentle as possible, preferably therapeutic. Surgical removal of tumors is carried out only in extreme cases when there is a threat to the patient’s life.

In the early stages of the adhesive process, vitamin E, folic acid and aloe preparations are used. Such products prevent the formation of new splices and make existing ones more elastic.

In acute cases of pathology, laparoscopy is indicated. With its help, the cords are cut, which allows the normal functioning of the affected organs to be restored. Particular attention is paid to physiotherapy and nutritional therapy, which alleviate the patient’s painful condition.

Medicines

Treatment of postoperative connective tissue adhesions is carried out both surgically and more conservatively, that is, by medication. Medicines against adhesions are divided into:

• Fibrinolytic agents - these drugs contain substances that dissolve fibrin around tissue adhesion. Fibrinolysin, Urokinase, Hyaluronidase, Chemotrypsin, Streptokinase, Trypsin, as well as tissue plasminogen activators.
• Anticoagulants – prevent blood clotting. Drugs from the group of Citrates and Oxalates, Heparin.
• Antibacterial and anti-inflammatory drugs - prevent the development of infectious and inflammatory complications. Most often, patients are prescribed drugs from the group of tetracyclines, cephalosporins, sulfonamides, NSAIDs, antihistamines or corticosteroids.

Let's consider the most effective drugs prescribed to patients for postoperative cords of any location:

1. Streptokinase

A fibrinolytic agent that dissolves blood clots. It affects the enzyme system and dissolves fibrin in blood clots.

• Indications for use: blockage of the pulmonary arteries and its branches, thrombosis, blockage of the vessels of the retina, acute myocardial infarction during the first 10-12 hours, formation of cords on internal organs.
• Method of administration: the drug is administered intravenously, in rare cases intra-arterially. The initial dosage is 250,000 IU (IE) dissolved in 50 ml of isotonic sodium chloride solution. In case of severe adhesions, the medication must be administered over a long period of time.
• Side effects: headaches, nausea, chills, allergic reactions, nonspecific reactions to protein.
• Contraindications: increased bleeding, recent bleeding, stomach ulcers, microbial diseases, pregnancy, diabetes, severe kidney and liver diseases, active tuberculosis, hypertension.

1. Chemotrypsin

Local application of this drug breaks down necrotic tissue and fibrinous formations, helps to liquefy viscous secretions, exudate and blood clots. Contains the active component – ​​chymotrypsin.

• Indications for use: thrombophlebitis, inflammatory-dystrophic form of periodontal disease, otitis media, tracheitis. Used during physiotherapy to treat adhesions.
• Directions for use: intramuscularly, 0.0025 g once a day. For injection, the drug is dissolved in isotonic sodium chloride solution. The solution is injected deep into the buttocks. The course of treatment is 6-15 injections.
• Side effects: burning at the site of application, allergic reactions, bleeding from healing sites.
• Contraindications: individual intolerance to active components, intravenous administration, bleeding wounds, malignant neoplasms.

1. Hyaluronidase (Lidase)

An enzymatic agent used to eliminate joint contractures, soften scar formations and treat hematomas. Contains hyaluronic acid.

• Indications for use: cicatricial changes in the skin of various origins, hematomas, joint contractures, long-term non-healing ulcers, scleroderma, traumatic lesions of the nerve plexuses, rheumatoid arthritis.
• Method of administration: the drug is administered subcutaneously under scar tissue, intramuscularly, using electrophoresis, applications to the mucous membranes. In ophthalmic practice, the medicine is used subconjunctivally and retrobulbarly. The course of therapy is individual for each patient and depends on the severity of the pathological process.
• Side effects: allergic skin reactions.
• Contraindications: malignant neoplasms.
• Overdose: in rare cases, allergic skin reactions occur.

1. Urokinase

Fibrinolytic, dissolves blood clots by activating plasminogen.

• Indications for use: thromboembolic occlusive vascular diseases, local thrombosis, coronary thrombosis, bleeding in the anterior chamber of the eye and vitreous body, local treatment of adhesions.
• Directions for use: average dose 1000-2000 IU/kg/hour, duration of therapy is determined by the attending physician.
• Side effects: shock, changes in liver tests, attacks of nausea and vomiting, loss of appetite, increased body temperature, headaches, deterioration in general health, allergic skin reactions.
• Contraindications: hemorrhagic stroke, bleeding, recent biopsy, arterial hypertension, recent surgery, severe renal or liver failure, pregnancy.

1. Fibrinolysin

Affects the blood system and fibrinolysis. Very often used in combination with Heparin. Its activity is based on the body's natural anticoagulant system and the ability to dissolve fibrin threads.

• Indications for use: blockage of blood vessels by a blood clot in the peripheral or pulmonary arteries, recent myocardial infarction, acute thrombophlebitis.
• Directions for use: intravenously (drip) with isotonic sodium chloride solution, topically.
• Side effects: increased body temperature, pain at the site of application, allergic reactions, chills.
• Contraindications: increased bleeding, peptic ulcer of the stomach and duodenum, tuberculosis, radiation sickness, low levels of fibrinogen in the blood.

If the adhesive process is accompanied by severe pain, then Paracetamol, No-shpu or Spazmalgon are used to eliminate them. When using anti-adhesive drugs locally, electrophoresis, applications and other physical procedures are performed.

Ointments for adhesions after surgery

To resolve connective tissue adhesions and scars, topical preparations, that is, ointments, are widely used. The following remedies are effective for adhesions after surgery:

1. Vishnevsky ointment

An antiseptic that contains castor oil, xeroform and tar. Widely used in the treatment of inflammation caused by abscesses or boils. Restores tissue in case of burns, bedsores and frostbite, used in gynecology. Helps soften postoperative scars and adhesions.

The ointment is evenly distributed over gauze and applied to the affected areas. The dressings are changed 2-3 times a day. A slight irritant effect on tissue receptors accelerates the regeneration process. Long-term use of the product may cause allergic reactions and skin irritation. The main contraindication is kidney disease.

1. Ointment Tsel-T

Homeopathic chondroprotective agent with a wide spectrum of action. It has protective, anti-inflammatory and analgesic properties. Contains active plant components that reduce swelling and have a therapeutic effect on cartilage, bone and soft tissue. The drug is effective in the treatment of postoperative adhesions and scars.

The medicine contains chondroitin sulfate (a structural element of cartilage tissue), sius-organ components that slow down degenerative changes in cartilage tissue, improve microcirculation and help enhance plastic processes and biocatalysts of the body's redox reactions.

• Indications for use: various diseases of the musculoskeletal system (osteochondrosis, tendinopathy, spondyloarthrosis, osteoarthritis deformans), injuries and surgical interventions, after which adhesions and contractures have formed.
• Directions for use: a small amount of ointment should be applied to the affected area 2-5 times a day. The product can be used during massage and various physiotherapeutic procedures.
• Side effects: allergic reactions, skin itching, rash. Overdose symptoms have not been recorded. The ointment is contraindicated in case of individual intolerance to its components.

1. Heparin ointment

Reduces the inflammatory process, prevents blood clotting, dilates superficial vessels, and relieves pain.

• Indications for use: thrombophlebitis of the extremities, phlebitis, thrombosis of hemorrhoidal veins, ulcers of the extremities, postoperative cords.
• Directions for use: the ointment is applied to the affected area of ​​the skin 2-3 times a day. The product can be used under a gauze bandage during a massage.
• Contraindications: ulcerative-necrotic processes, decreased blood clotting, thrombopenia.

1. Hydrocartisone ointment

Inflammatory and allergic skin lesions of non-microbial etiology, allergic and contact dermatitis, eczema, neurodermatitis, resorption of postoperative scars and cords. The product is applied to the skin in a thin layer 2-3 times a day. The ointment is contraindicated for infectious skin diseases, pyoderma, mycoses, ulcerative lesions and wounds.

Gels for adhesions after surgery

In addition to ointment, gel can be used to treat adhesions. This dosage form does not contain fats and oils, is viscous and soft in composition and consistency. The gel consists of 70% thickeners and water, so its active components quickly penetrate the wound surface.

Let's consider popular gels for adhesions after surgery:

1. Traumeel gel

A complex homotoxic agent with regenerating, analgesic, anti-inflammatory and anti-exudative properties. Quickly relieves swelling and stops bleeding. Increases vascular tone and reduces their permeability.

• Indications for use: inflammatory processes of the musculoskeletal system, bruises, injuries, sprains, fractures, severe pain, prevention of postoperative complications, including adhesions, purulent-inflammatory diseases.
• The gel is applied in a thin layer to the affected area of ​​the skin 2-3 times a day; the product can be used under a bandage.
• Side effects manifest themselves in the form of local allergic reactions, itching and redness. The main contraindication is intolerance to the components of the drug.

1. Interkot

Gel used during laparotomy and laparoscopic operations in gynecology and surgery to reduce the number of postoperative cords. The absorbent agent is a combination of polyethylene oxide and sodium carboxymethylcellulose.

• Indications for use: open and closed surgeries in the abdominal cavity and pelvic organs. The medicine is available in a special syringe, which makes it easier to use. Easily applied and resolves connective tissue adhesions within four weeks.
• Contraindications: infectious processes or complications.

1. Contractubex

Antiproliferative, anti-inflammatory, softening and smoothing drug. Contains an active substance - onion extract, which reduces the release of anti-inflammatory mediators in the area of ​​application and allergic reactions. Reduces the growth of fibroblast cells and has bactericidal properties. The gel also contains heparin and allantoin, which accelerate the healing process, improve tissue permeability, and slow down collagen synthesis.

• Indications for use: postoperative and post-traumatic scars and cords, Dupuytren's contracture, keloids, traumatic contractures.
• Directions for use: a small amount of gel should be applied to the postoperative scar and rubbed in until completely absorbed. The product can be used under a bandage.
• Side effects manifest themselves in the form of local allergic reactions. The gel is contraindicated in case of individual intolerance to its components.

1. Mesogel

Anti-adhesion agent based on carboxymethylcellulose polymer. It is used for surgical interventions after which there is a risk of developing adhesions. Does not have a general toxic, local irritant or allergenic effect. Effective in the presence of exudate or blood, is not encapsulated and is not a breeding ground for pathogens.

The mechanism of action of the gel is based on the separation of damaged surfaces until they are completely healed. The drug creates conditions for normal movement of organs and reduces fibrin levels. Available in sterile syringes with a volume of 5-100 ml and in polymer containers of 200 ml.

• Indications for use: prevention of cord formation during operations on organs and tissues with increased formation of adhesions.
• The method of administration and dose depend on the packaging of the medicine and the surgical procedure. The gel is applied to tissue areas where cords may form. The product is applied in a thin layer over the surface to be treated, thereby creating a reliable coating while the tissue heals.
• Contraindications: hypersensitivity to cellulose ethers, any disease at the stage of decompensation, terminal conditions, kidney and liver diseases, acute stage of purulent peritonitis.

After application, Mesogel gradually dissolves, and its concentration decreases through an increase in volume and splitting of its molecules into short fragments. If the drug is used in the abdominal cavity, then its molecules are absorbed into the capillary network of the peritoneum and penetrate the lymphatic system through the serosa of the intestine. Most of the drug is excreted in the urine, and the rest breaks down into glucose, water and carbon dioxide.

Suppositories against adhesions after surgery

For the prevention and treatment of connective tissue adhesions after surgery (especially during gynecological or urological procedures), suppositories against adhesions are recommended. After surgery, you can use the following medications:

1. Ichthyol candles

They have antiseptic, anti-inflammatory and local anesthetic properties. They are used for neuralgia, inflammatory pathologies of the pelvic organs, after recent surgical interventions. Suppositories should be administered after a cleansing enema; the duration of therapy and frequency of use are determined by the attending physician.

1. Longidaza

Suppositories for vaginal or rectal use. The drug is a macromolecular complex of the proteolytic enzyme hyaluronidase with a high-molecular carrier. It has pronounced anti-edematous, anti-inflammatory, immunomodulating, antioxidant properties. Increases the permeability and trophism of tissues, resolves hematomas, increases the elasticity of scar changes. Reduces and completely eliminates adhesions and contractures, improves joint mobility.

• Indications for use: diseases accompanied by the proliferation of connective tissue. Most often prescribed in urological and gynecological practice, in surgery, cosmetology, pulmonology and phthisiology, after surgical interventions in the abdominal cavity and long-term non-healing wounds.
• Directions for use: suppositories are administered rectally after cleansing the intestines, 1 suppository once every 48 hours, or 1 vaginally. once every three days. The duration of therapy is determined by the attending physician. If necessary, a second course of treatment may be prescribed, but not earlier than 3 months after the end of the previous one.
• Side effects: systemic or local allergic reactions.
• Contraindications: intolerance to active components, severe renal dysfunction, malignant neoplasms, patients under 12 years of age. It is prescribed with extreme caution for patients with renal failure, recent bleeding, and acute forms of infectious disease.

In addition to the suppositories described above, you can use tampons with various ointments, for example with heparin or Vishnevsky ointment.

Vitamins

To treat and prevent the formation of adhesions after surgery, patients are recommended to take vitamins. Tocopherol (vitamin E) and folic acid (vitamin B9) have proven themselves well in the fight against cords.

1. Tocopherol

Vitamin E is an active antioxidant that protects various substances from oxidation, for example, retinol or polyunsaturated fatty acids. A natural antioxidant is involved in protein biosynthesis, tissue respiration and important processes of cellular metabolism. Its deficiency leads to degenerative changes in nerve cells and damage to the tissues of internal organs, especially the liver parenchyma.

• Indications for use: muscular dystrophy, central nervous system diseases, dermatoses, peripheral vascular spasms, various motor activity disorders, complex treatment of cardiovascular and ophthalmological diseases.
• The method of administration and dosage depend on the form of the drug, indications for use and the individual characteristics of the patient’s body.
• Side effects: increased doses of the vitamin cause gastrointestinal disorders, decreased performance and creatinuria.
• Contraindications: destructive changes in the heart muscle, myocardial infarction, high risk of thromboembolism.

Vitamin E deficiency may be associated with a decrease in red blood cells. The vitamin has several forms of release: bottles, oil solution, capsules for oral administration, ampoules for intravenous or intramuscular administration.

1. Folic acid

Belongs to the group of vitamins B. It enters the body with food and is synthesized by intestinal microflora. Participates in important metabolic processes in the body and is necessary for choline metabolism. Stimulates blood formation processes. It comes in tablet form.

After oral administration, it is completely absorbed in the duodenum and proximal parts of the small intestine. About 98% of the dose taken enters the blood within 3-6 hours. Metabolizes in the liver, 50% is excreted in the urine, the rest in feces.

• Indications for use: hyperchromic macrocytic and megaloblastic anemia, normalization of erythropoiesis, anemia and leukopenia, pellagra, pernicious anemia, postoperative conditions, improvement of the condition of the epidermis.
• Directions for use: tablets are recommended to be taken orally after meals. As a rule, 3-5 capsules during the day. The course of treatment is 20-30 days.
• Side effects: in rare cases, allergic reactions occur, which can be controlled with antiallergic medications.
• The main contraindication is individual intolerance to folic acid. No cases of overdose have been recorded.

To speed up recovery and minimize the risk of adhesions, vitamins must be taken daily. Particular attention should be paid to a balanced diet with micro and macroelements, minerals and, of course, vitamins necessary for the body.

Physiotherapeutic treatment

Physiotherapeutic treatment is considered one of the effective methods for eliminating postoperative adhesions. Most often, such therapy is prescribed for adhesions in the pelvic organs.

The main purpose of physiotherapy:

• Activation of tissue metabolism - due to physiotherapy, blood circulation and metabolism in the affected tissues improves. This helps prevent compression and twisting of organs.
• Softening of connective tissue - due to the impact of physical factors on connective tissue, it becomes more elastic. This minimizes pain and the risk of developing intestinal obstruction or fallopian tube obstruction.

The most noticeable effect is possible in the first months of the disease, when the cords are not too hard and strong. Treatment prevents their strengthening and prevents the growth of new tissue. During the adhesive process the following methods are used:

• Ozokerite and paraffin applications.
• Electrophoresis with absorbable and analgesic drugs.
• Laser or magnetic therapy.
• Electrical stimulation.
• Ultrasound and massage.
• Hirudotherapy.

Let's take a closer look at the most effective physiotherapy procedures:

1. Ozokerite and paraffin applications are aimed at warming the pelvic organs. Their action is similar to laser therapy and ultrasound. Increase local immunity, stimulate blood circulation and lymphatic drainage. Applications are contraindicated for inflammatory lesions of the pelvis and skin diseases.
2. Ultrasound is a method of influencing organs and tissues using ultrasonic waves. Accelerates metabolic processes at the molecular level. Promotes the destruction of pathogenic microorganisms in chronic foci of infection. Destroys the microstructure of adhesions and increases their elasticity.
3. Laser therapy – heating the affected tissues to stimulate blood circulation and prevent the formation of collagen protein (the basis of adhesive and scar tissue). This method is especially effective in the early stages of the pathological process.
4. Electrical stimulation is based on sending electrical impulses using a special device to the affected tissues. Stimulates blood circulation and lymphatic drainage, enhances regeneration processes, minimizes pain.
5. Electrophoresis - this procedure consists of hardware and medicinal effects. Using an electric field, medications containing the enzyme hyaluronidase (Lidase, Longidase and others) are introduced into the body. Electrophoresis is especially effective in the first months after surgery, as it prevents the formation of strands. With its help, you can restore the functioning of organs even with neglected connective tissue formations. The technique is absolutely painless, but has a number of contraindications: severe intoxication, blood diseases, oncology, cachexia, heart rhythm disturbances, intolerance to the medications used.
6. Treatment with leeches (hirudotherapy) - the effectiveness of this method is based on the enzyme hyaluronidase, which is part of leeches. It softens the adhesions and makes them permeable to drugs, reducing their size. As a result of this treatment, organ mobility is restored and pain is reduced. Leeches are placed on problem areas for 30-40 minutes. In this case, there should be no wounds or other damage on the skin. As a rule, patients are prescribed 7-10 sessions. This method has no contraindications or side effects.

Physiotherapeutic treatment is also carried out for advanced adhesions that have led to deformation of organs and the appearance of acute pathological symptoms. This therapy can minimize pain and improve the patient’s condition.

Traditional treatment

In addition to drug and surgical treatment of postoperative cords, alternative treatment is often used to eliminate them. Alternative therapy helps prevent the growth of tumors. Consider popular folk recipes:

• Take 50 g of flax seeds, wrap them in a piece of gauze and dip them in 500 ml of boiling water for 5-10 minutes. Cool and apply to the sore spot for 1-2 hours 2-3 times a day.
• Pour a tablespoon of dry St. John's wort herb into 250 ml of boiling water and simmer over low heat for 10-15 minutes. Strain the resulting broth and take ¼ cup 3 times a day.
• Take two parts each of rose hips and nettles, mix with one part lingonberries. Pour 250 ml of boiling water over the resulting mixture and let it brew for 2-3 hours. Take ½ glass twice a day.
• Take equal parts of sweet clover, centaury and coltsfoot grass. Pour 250 ml of boiling water and let it brew for 1.5 hours. Take ¼ cup 3-5 times a day.
• Black cumin oil, which can be purchased at a pharmacy, has medicinal properties. It contains phytosterols, tannins, carotenoids and fatty acids. Has antibacterial, regenerating and anti-inflammatory effects. The oil can be used to wet tampons, for douching, for external or internal use.
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Herbal treatment

Another option for traditional treatment of adhesions is herbal treatment. Consider popular herbal recipes:

• Grind three tablespoons of bergenia roots and pour 300 ml of water over them. The product should infuse for 3-4 hours, preferably in a thermos or tightly closed container. Strain and take 2-3 teaspoons an hour before meals. The course of treatment is three days, after which you need to take a break of 2-3 days and continue therapy again.
• Take an aloe (at least 3 years old), cut a couple of leaves and put them in a cool place for 48 hours. Grind, add 5 tablespoons of honey and 50 ml of milk. Mix all ingredients well and take 1 tablespoon 3 times a day.
• Pour a tablespoon of milk thistle seeds into 200 ml of boiling water and boil for 10 minutes. After cooling, the broth should be filtered and taken 15 ml 3 times a day.
• Pour 50 g of crushed Maryina root into 1 liter of vodka and let it brew for 10 days in a dark place. The infusion should be taken 40 drops for a month, 2-3 times a day before meals. After this, you need to take a break of 10 days and repeat the treatment again.

Herbal treatment should be carried out with extreme caution and only after medical permission. Particular attention should be paid to the proportions of medicinal components.

Homeopathy

To treat cords of different locations, not only traditional medicine, but also alternative methods are used. Homeopathy is one of the latter. For postoperative adhesions, the following drugs are recommended:

• Arsenicum album – painful growths after injuries.
• Calcarea fluorica – cords after operations, deep wounds and various injuries.
• Cundurango - accretion and ulceration in the oral cavity.
• Dulcamara, Euphrasia, Plumbum, Rhus toxicodendron, Thuja – growth of connective tissue in the nose.
• Ranunculus bulbosus – cords after pleurisy.
• Silicea – used for fusions after operations, injuries and wounds. Stimulates the body to accelerate the resorption of fibrous formations and scar tissue.

Homeopathic medicines can only be taken as prescribed by a homeopathic doctor, who selects the medicine (dosage, course of treatment) individually for each patient.

Surgical treatment

If the adhesive process is advanced or acute and causes pathological symptoms from the internal organs, then surgical treatment is indicated. The main goal of such therapy is the mechanical removal of inclusions that disrupt the blood supply and interfere with the normal functioning of the gastrointestinal tract and other organs.

Surgical treatment can be carried out using the following methods: laparoscopy and laparotomy. This takes into account the fact that abdominal surgery can cause new connective tissue adhesions. Therefore, when choosing a method, preference is given to the less traumatic one.

Refers to low-traumatic operations. Through a puncture in the abdominal cavity, the doctor inserts a fiber-optic tube with a miniature camera and lighting. Surgical instruments are inserted through additional incisions, with the help of which adhesions are cut and blood vessels are cauterized. Dissection can be performed using an electric knife, laser, or hydraulic pressure. After such an operation, recovery is quick and with minimal complications. But there is still no guarantee that a relapse will not happen again.

1. Laparotomy

Prescribed for a large number of adhesions. The operation is performed through an incision (10-15 cm) of the anterior wall of the peritoneum to gain extensive access to the internal organs. The method is traumatic, recovery is long with a mandatory course of anti-adhesion physiotherapy.

When choosing surgical treatment tactics, many factors are taken into account. First of all, this is the age of the patient. Elderly patients undergo only laparoscopy. Another factor is the presence of concomitant pathologies and general health. If the patient has serious diseases of the cardiovascular or respiratory system, then this is a contraindication to surgery.

Particular attention should be paid to the postoperative period. It is necessary to provide the intestines with functional rest until the wounds are completely healed. To do this, you should refuse food in the first days after surgery and take only liquids. On the second or third day, you can gradually take liquid dietary foods (broths, grated cereals, vegetable purees). As the condition improves, that is, after about 7-10 days, you can gradually restore the diet.

After surgery, it is strictly contraindicated to consume alcohol, strong coffee and tea, confectionery, spicy, salty, fatty or fried foods. Following a diet allows you to quickly recover after treatment and prevent the appearance of new cords.

Removal of adhesions after abdominal surgery

Many patients, after surgical interventions or prolonged inflammatory processes, develop scars, that is, cords. Such adhesions disrupt the functioning of internal organs and cause acute pain. This is the main indication for removing adhesions. After abdominal surgery, the laparoscopic method is most often used.

If the pathological process is advanced, then laparotomy is performed. This method has the following indications:

• Overgrowth of connective tissue throughout the abdominal cavity.
• The appearance of purulent formations in the intestines.
• Severe intestinal obstruction.
• Acute inflammatory process in the abdominal cavity.

During laparotomy, access to the internal organs is carried out through an incision in the abdominal wall, that is, as in a full abdominal operation. During laparoscopy, several small incisions are made through which equipment is inserted. In both the first and second cases, the operation lasts about 1-2 hours. The patient will have a long recovery period and a set of preventive measures.

Exercises against adhesions after surgery

One of the methods of preventing cords is therapeutic exercises. Exercises against adhesions after surgery are aimed at activating the local blood supply to the affected tissues and internal muscle fibers, increasing their elasticity.

Let's consider an approximate set of anti-adhesive exercises:

• Sit on the floor and stretch your legs straight. Bend them at the knees and pull them towards your chest, slowly straightening them to the starting position.
• Lie on the floor, put your hands behind your head, legs bent at the knees and standing on the floor. Slowly lift your shoulder blades.
• Lying on the floor, bend your knees, press your shoulder blades to the floor, extend your arms along your body. Gradually lift your pelvis, lowering your knees to your chest, and return to the starting position.
• Lie on the floor, place your hands under your buttocks, legs straight and elevated. Make crossing movements with your legs (scissors). Another version of this exercise is a bicycle, and the movements should be with a large amplitude, directed towards the peritoneum and chest.
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Nutrition is important both preventively and restoratively. Let's look at the basic dietary recommendations:

• You should not starve or overeat, as this aggravates the pathological condition and can cause complications.
• You should follow a meal schedule at certain times. Meals should be fractional, you need to eat in small portions 4-6 times a day.
• Heavy and fatty foods, foods high in fiber and those that cause flatulence (legumes, cabbage, radishes, turnips, radishes, grapes, corn) should be excluded from the diet. Carbonated and alcoholic drinks, hot seasonings and sauces, and whole milk are prohibited.
• The menu should include foods rich in calcium, that is, cottage cheese, cheese, fermented milk products. They promote intestinal motility. In this case, food should be at room temperature, since too cold or hot can cause cramps.
• Patients should consume low-fat broths, steamed, boiled or baked lean meats and fish. You can eat greens, vegetables and fruits. In this case, you should avoid marinades and smoked meats.

To prevent the development of adhesions, you need to treat constipation in time, avoid food poisoning and inflammatory processes. You should lead an active lifestyle, but avoid strenuous physical activity. The above recommendations minimize the risk of developing pathology.

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It is important to know!

Moderately traumatic surgical interventions can cause significant pain after surgery. At the same time, traditional opioids (morphine, promedol, etc.) are not suitable for patients after such operations, since their use, especially in the early period after general anesthesia, is dangerous for the development of central respiratory depression and requires monitoring the patient in an intensive care unit.

Among many people who have undergone surgery on the abdominal organs, there is a misconception that after this, adhesions will necessarily form, due to which they experience discomfort and pain. Supposedly this is inevitable and we need to come to terms with it. Unfortunately, some medical professionals think so too.

However, more than thirty years of practice in monitoring and treating such patients allows us to look at this problem more optimistically. There are simple methods that are available to everyone and help avoid possible complications.

What are adhesions? This is additional tissue in the interorgan spaces of the abdomen (in the form of strangely shaped films, cords, threads), which was formed as a result of inflammation. Adhesions limit the elasticity and mobility of internal organs and make it difficult for food to move through the intestinal lumen. Sometimes they can even cause acute intestinal obstruction. In milder cases of the disease, adhesions periodically or constantly cause discomfort, bloating occurs, and cramping or aching pain appears. Such patients experience intolerance to rough, poorly digestible food, a tendency to constipation, decreased ability to work, and fatigue.

But the formation of adhesions in the abdomen does not depend on the actions of surgeons. This is a biologically natural reaction of the body, essentially aimed at delimiting the zone of inflammation in the abdomen. As the inflammation subsides, the adhesions dissolve without a trace within 3-6 months. However, in some cases, under the influence of unfavorable factors and characteristics of inflammation, they still remain and their development continues. They become rough, dense, very similar to scars at the sites of mechanical damage to the skin of our hands and feet. How to avoid adhesive disease? After surgery on the abdominal organs, already on the second day, if your general condition allows, you need to start turning over in bed and preferably be on one side or the other for at least a few minutes, periodically taking deep breaths and exhalations. And as soon as the wounds on the abdomen heal - this is approximately 8-12 days after the operation - you should begin to perform slight bends and turns of the torso. The more often the patient displaces the internal organs in this way, the more it will prevent them from sticking and sticking together. A few words about nutrition. After surgery, some dietary restrictions are necessary. You should eat easily digestible food in liquid and semi-liquid form, drink natural juices, and take multivitamins with microelements. It is advisable to eat frequently and in small portions: 6-8 times throughout the day in small portions. This stimulates the movement (peristalsis) of the intestine. What can be advised to those who have suffered from adhesive disease for many years? The resorption of adhesions can be accelerated by complex treatment using enzyme therapy. For this purpose, the clinic uses injections of lidase, lyrase and other drugs with the ending...ase: streptase, urokinase, ribonuclease. Rubbing ointments, gels, balms, creams containing anti-inflammatory, analgesic substances and herbal enzymes into the abdominal wall is useful. At the same time, organ massage is performed.

Valery Ivanovich OSIPOV, Professor, Department of Faculty Surgery, Chita Academy of Sciences,
Healthy lifestyle magazine, 4/58 2008

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COMMENTS

Victor Sergeew / 2019-06-30

Hello, can you tell me why, after surgery for intestinal obstruction, I myself lost a lot of weight, but my stomach seems to be bloated.