Adhesions after abdominal surgery symptoms. Reasons for the formation of adhesions after surgery? Treatment of intestinal adhesions with folk remedies

Spikes are strings of connective tissue, formed as a result of surgical interventions or all kinds of inflammation, stretching from organ to organ. Sometimes there are cases where adhesions form in the abdominal cavity and pelvis; such adhesions can block the path to conception, therefore it is necessary to constantly be examined, and if they are found, they must be eliminated.

Adhesions after surgery - what is it?

The organs of the pelvis and abdominal cavity (fallopian tubes, the uterus itself, bladder, ovaries, rectum) are usually covered on the outside with a thin, bright membrane - the peritoneum. A small amount of fluid and smoothness of the peritoneum ensures fairly good displacement of the uterine loops, fallopian tubes. IN normal operation intestines there are no problems with the capture of the fallopian tube by the egg, the growth of the uterus does not interfere with good functioning Bladder and intestines.

Peritonitis - inflammation of the peritoneum is a very dangerous disease. The more inflammation the the disease is more dangerous. The body has a mechanism that limits the spread of this disease, this is the formation of adhesions.

During the inflammatory process, tissues become swollen, the peritoneum becomes covered with a sticky coating that contains fibrin - this is the protein that forms the basis of a blood clot. Regarding this thin film fibrin at the site of inflammation, one might say, glues the surfaces to each other, the result of this action is a mechanical obstacle to the inflammatory process. After the inflammatory process has ended, adhesions (transparent - whitish) films can form in the places of gluing. They are called spikes. The main function of adhesions is to protect the body from pus and inflammation in the peritoneum.

But we would like to note that during the inflammatory process, adhesions do not always form. If treatment began on time and all procedures were carried out correctly, the likelihood that adhesions will form in the body decreases. But still, adhesions form when the disease progresses to chronic process and drags on over time.

These adhesions after completion of gynecological surgery interfere with the normal functioning of internal organs. If the mobility of the intestinal loops is impaired, this can lead to intestinal obstruction. Adhesions that affect the fallopian tubes, ovaries, and uterus disrupt the functioning of the body (the egg enters the fallopian tube, movement, and advancement of the embryo into the uterine cavity). Adhesions can be a major cause of infertility.

All kinds of inflammatory diseases;
Operations;
Endometriosis;
Thickened blood in the peritoneum.

Adhesions due to inflammation

The ovaries, uterus and fallopian tubes may be involved in adhesions, which can result from inflammation of the organs (eg appendicitis), in some cases when the colon and small intestine. In such cases, the genitals are not severely damaged - the process of formation of adhesions does not disturb the internal structure. When inflammation occurs in the genitals, a process of formation of adhesions occurs that disrupts the functioning of the genitals.

The most unprotected is the fallopian tube, which is the most delicate organ. Plays a major role in conception and maintenance of pregnancy.

Sperm that penetrate the vagina are, in turn, filtered through the mucus of the cervix, pass first into the uterine cavity, and then penetrate the fallopian tube. Speaking about the fallopian tube, we can say that it ensures the transportation of the embryo and germ cells, and creates an environment for the development of the embryo. A change in the composition of the mucus that appears in the fallopian tube can destroy the embryo. Immunity in the fallopian tube is minimal; there are practically no mechanisms there that would reject foreign substances; excessive immune activity is unfavorable for pregnancy. The fallopian tubes are very delicate and easily become victims of infections ( diagnostic curettage, abortion, hysteroscopy).

The infection affects the mucous membrane from the very beginning, then muscle layer, at the last stage, the outer layer of the fallopian tube is involved and conditions arise for the occurrence of so-called intestinal adhesions. If treatment of these adhesions is not carried out in a timely manner, scar tissue forms. The fallopian tube turns into a connecting sac and loses its ability to promote the egg. With such severe disorders, elimination of adhesions does not restore the function of the fallopian tube; the presence of this focus of inflammation leads to infertility. In these cases, for pregnancy, the entire tube is removed.

Postoperative intestinal adhesions

After the operation has been performed, adhesions are formed in the following cases:

Tissue ischemia or hypoxia;
Drying fabrics;
Rough handling of fabric;
Foreign bodies;
Blood;
Separation of early adhesions.

To those foreign bodies that cause the formation of adhesions include particles from doctor’s gloves, cotton fibers from tampons and gauze, and suture material. Intestinal adhesions after gynecological surgery are a dangerous problem; such adhesions can also appear with endometritis. During menstrual cycle V abdominal cavity blood containing living cells of the membrane - the mucosa (endometrium) can enter. The immune system should itself remove these cells, but if there are disruptions in the immune system, the cells take root and form endometrial islands, and adhesions usually form around these foci.

Treatment of adhesions

Only under the visual control of an experienced surgeon should tumor isolation and separation of adhesions be carried out. The intestine is pulled back and upward with the finger of the surgeon's assistant or by the anatomical patient. If the tumor is located behind the abdomen, then in this case the peritoneum is dissected where there is no intestine above the upper pole of the tumor, and then the tumor is carefully and slowly isolated. To avoid damaging the intestine in any way, professional surgeons leave capsules or part benign tumor on the intestinal wall with dense adhesions. In some cases, it will even be better if you first cut the fibroid capsule in an accessible place, then enucleate it, and then carefully separate the intestine from the capsule or excise the capsule as carefully as possible without damaging the rectum.

Laparoscopy is considered a low-traumatic surgical intervention, which is performed for various indications. Complications after it occur extremely rarely, and the recovery period does not last long. But can adhesions form after laparoscopy? This operation is the most in a safe way treatment gynecological diseases. It is often used to eliminate adhesions, but it itself can be the cause of their formation.

- these are connective tissue seals that internal organs connect with each other. This goes against human anatomy. Adhesions after laparoscopy appear as transparent or whitish stripes. They lead to abnormalities in the functioning of the body. That is why the adhesive process is a pathological phenomenon and needs treatment.

Adhesions after ovarian laparoscopy rarely occur, but they extremely darken a woman’s life. They do not always make themselves felt, but sometimes they lead to the development of complications. In addition, the cause of the pathology can be inflammatory processes in the pelvic area. It is noteworthy that adhesions form at almost any age.

Factors contributing to the development of adhesions after laparoscopy:

diabetes;
damage to the layers of the peritoneum or their “overdrying” due to the filling of the abdominal cavity with carbon dioxide at an inappropriate temperature;
movement of bacteria into the surgical site from other parts of the body (this prevents normal recovery fabrics);
old age;
burn damage to tissue by a radio wave knife, plasma scalpel or other device during the coagulation process;
use that takes too long to dissolve;
oxygen starvation of tissues and wrong exchange substances in them;
leaving cotton balls, suture material, etc. in the area of manipulation;
development of postoperative infectious process(rarely happens).

Symptoms of adhesions in the pelvis

Signs of adhesions may be absent. As the postoperative scar thickens, it is possible that nagging pain on the operated area, intensifying with active movements, as well as pain during intimacy.

The following manifestations of pathology are possible:

development of intestinal obstruction;
improper functioning of internal organs;
pain in the pelvic area (abdominal or chronic);
menstrual irregularities;
infertility;
Availability uterine bleeding With unpleasant smell, not caused by menstruation.

What to do if adhesions form after laparoscopy

Changing food

If there is an adhesive process after surgery using the laparoscopic method, a change in diet is indicated to help eliminate the pathology as quickly as possible. Spicy, fried and fatty foods are excluded from the diet, as well as:

products that increase gas formation in the intestines;
alcohol;
hot and fatty sauces;
marinated and smoked dishes;
canned food

The menu for spikes should consist of fermented milk products, lean soups, lean meats and fish dishes, chicken eggs, fruits and vegetables, various cereals. It is optimal to eat small meals five to six times a day.

To avoid the development of adhesions, it is recommended to use an anti-adhesive gel, for example, Mesogel. It is rubbed into the skin in a thin layer. You can perform special exercises aimed at eliminating pathology. You can learn more about exercises against adhesions HERE.

Adhesion therapy

For asymptomatic pathology, it is indicated conservative therapy, suggesting the use medicines and undergoing physiotherapeutic procedures. If these methods are ineffective, then relaparoscopy is performed at the patient’s request.

Chronic painful form usually treated conservatively, including local impact on the affected tissues. Physiotherapy and electrophoresis procedures using absorbable agents (iodides and lidase) are practiced. Drugs are prescribed to relieve pain syndrome and other symptoms of pathology.

A patient who, as a result of an adhesive process, developed intestinal obstruction, is hospitalized in a hospital. Next, an analysis of the viability of the intestine is carried out and the issue of the need to capture healthy tissue is decided.

Laparoscopic removal of adhesions

Dissection of adhesions is carried out using laparoscopic access. In this case, three incisions (no more than a few millimeters in size) are made on the woman’s stomach. During the manipulation process, the normal ratio of organs is restored reproductive system, the adhesions are removed, and a new hole is formed in the fallopian tube to replace the sealed one.

Methods for removing adhesions:

laser therapy, in which adhesions after removal of the uterus and ovaries or other surgery are cut with a laser;
aquadissection – problematic tissues are removed using water supplied under pressure;
electrosurgery, in which an electric knife is used to eliminate adhesions in the pelvis.

Laparoscopy of formed adhesions rarely leads to complications. After this, the patient remains in the hospital for no more than two days. She is allowed to go home on the third day and from that moment on she is under the supervision of a gynecologist at her place of residence.

Prevention of adhesions formation after laparoscopy

To prevent adhesions after laparoscopic surgery, it is necessary to focus not only on drug treatment. The patient needs to move carefully after the operation, temporarily giving up active sports. Below are other measures to prevent the development of pathology.

Helps avoid the formation of adhesions drug therapy, consisting of antibacterial and anti-inflammatory drugs, as well as anticoagulants and fibrinolytic agents. The action of the latter is aimed at preventing the growth of fibrin - the main component of adhesions. Longidaza, Wobenzym, Ascorutin are often prescribed. Collection No. 59 normalizes women's reproductive function, eliminates the inflammatory process in the ovaries, reduces the likelihood of the formation of adhesions.

Drug therapy lasts 2-4 weeks. As practice shows, in women who undergo it, adhesions develop less frequently than in those who neglect doctor’s prescriptions.

Another way to prevent pathology is the introduction of a barrier fluid into the abdominal cavity, which prevents the connection of tissues with fibrin threads. Due to a special solution, the organs stop touching and “sticking” to each other.

softening of connective tissue. As a result, it becomes more elastic, which reduces the severity of pain and promotes the prevention and treatment of adhesions.
improvement of metabolism in tissues. Adhesions often lead to compression of organs, which is the cause of chronic constipation and menstrual irregularities. Physiotherapy normalizes metabolism and blood supply to tissues, stimulating the regeneration of the latter.

Therapeutic massage is usually used in conjunction with physiotherapy. It is contraindicated for some patients. Obstacles to its implementation are:

any cancer;
Availability infectious disease caused by laparoscopy;
integrity violations skin in the pelvic or abdominal area.

Moderate physical activity and performing special exercises. Before you start, you should consult your doctor.

To avoid adhesions, you need to adhere to a certain diet. In addition, infection should not be allowed to enter the seam, and it is also forbidden to play sports for some time. The right image life significantly reduces the likelihood of developing pathology.

It is advisable that the specialist explain to the patient all measures to prevent adhesions. This is important to do before a hysterectomy or any other surgery. A woman is unlikely to have to undergo repeated laparoscopy of the appendages if she is attentive to her health and avoids strong physical activity and follow all doctor's instructions postoperative period.

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 because the surface surgical field significantly less 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 inner surface 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 Negative influence 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;
promote the appearance in the organ painful sensations and spasms.

Sometimes the adhesion is so powerful that it can disrupt anatomically correct position 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 have arisen after abdominal surgery can cause pain in the various departments spine, joints, lead to changes in posture and disruption of body 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 organism itself, its anatomical structure, 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 launch full recovery in possible individual conditions for the whole organism.

Any surgery, no matter how minimally gentle it may be, leaves behind a lot of negative changes, injuries and stress that 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 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 doctor, chiropractor, endoscopist surgeon.

Which are formed as a result of surgery, inflammation or injury. Any surgical intervention in the pelvis or abdominal cavity leads to adhesions. Protection of a living organism from the spread of purulent inflammatory processes throughout the abdominal cavity is the main function of adhesions.

Postoperative adhesions.

Adhesions after surgery are formed due to:

Rough manipulation of fabric;

Presence of blood;

Ischemia or tissue hypoxia (insufficient supply of blood and oxygen to tissues);

Drying tissue during surgery.

Foreign bodies that cause adhesions include particles of adhesions from doctor’s gloves, fibers from tampons or gauze. are also formed with endometriosis. This is when a small amount of blood containing cells from the lining of the uterus enters the abdominal cavity during menstruation. These cells can be removed using your own immunity; in case of any problems, they live in functioning islets, which are released into the abdominal cavity. Adhesions are formed near these islands.

Adhesions after surgery: symptoms.

Adhesive disease can begin in the form of gradual or sudden increasing pain, increased bowel movements (peristalsis), which may be accompanied by a rise in temperature, severe vomiting, weakness and decrease blood pressure.

Adhesions after surgery: diagnosis.

The presence of scars and various adhesions in the abdominal cavity can be suspected in patients who have suffered from pelvic disease, in women who suffer from endometriosis or have undergone surgery in the abdominal cavity.

It will allow us to assume the presence of adhesions in the abdominal cavity of a woman with a probability of 75% using ultrasound examination, but the patency of the fallopian tubes will not exclude the presence of these adhesions, which seriously interferes with pregnancy. Promising diagnostic methods are magnetic resonance imaging (MRI) or nuclear magnetic resonance (NMR). Thanks to this method, pictures are taken that show general state body and the course of the disease.

Laparoscopy is one of the main methods for diagnosing adhesions, which allows you to assess the severity and treat adhesions on early stages their manifestations. There are three stages of adhesions formation:

Stage I, adhesions are located around the fallopian tube or ovaries.

Stage II, adhesions are located between the fallopian tube and the ovaries.

Stage III, a dense blockage of the egg occurs.

Adhesions after surgery: treatment

The main way Treatment of adhesions after surgery is laparoscopy. Special micromanipulators perform adhesiolysis - this is the dissection and removal of the adhesive process. The method of separating adhesions includes aquadissection, electrosurgery, and laser therapy. To prevent new formations after laparoscopy, use following methods:

Wrapping the ovaries and fallopian tubes with a special polymer absorbable film;

Introduction of a barrier fluid (povidine, dextran) between anatomical structures.

Prevention

Among preventive measures the most important thing is to stop the process of adhesions, or reduce their number, density and distribution in the abdominal cavity, while maintaining the normal healing process.

All prevention methods can be divided into groups:

1. Surgical methods and their use;

2.Usage medicines and mechanical barriers - so-called additives;

3. Physiotherapeutic procedures.

Whatever the disease, it is much easier to prevent it than to treat it later. Be healthy!

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

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

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

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

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

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

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

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

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

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

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

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

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

Methods for preventing adhesive disease

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

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

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

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

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

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

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

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

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

restoration of water and electrolyte balance in the body;
carrying out anti-inflammatory and anticoagulant therapy;
early activation of the patient;
maximum quick recovery bowel functions.

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