Adhesiolysis

Surgery adhesiolysis performed to remove or separate adhesions, which are bands of scar tissue that bind the organs or tissues together improperly. These adhesions are primarily caused by any abdominal or pelvic surgery, an infection, inflammation, and/or trauma and can cause pain, bowel obstruction, infertility, and/or organ movement limitation. 

Why is Adhesiolysis Done?

The adhesiolysis can be suggested in cases where adhesions bring about:

• Chronic abdominal or pelvic pain.
• Bowel obstruction (intestinal).
• (fallopian tube or pelvic adhesions) – WHO definition of infertile women.
• Organ limited function (e.g., bowel hypomotility) 
• The challenge in repeat operations.

Types of Adhesiolysis

Laparoscopic 

• Keyhole surgery 
• Minimally invasive 
• Less pain, faster recovery, fewer adhesions.

Open 

• Applied to severe, dense or complicated adhesions.
• Risks of new adhesion formation increased.

Advantages of adhesiolysis

• Freedom from long-term pain 
• Bowel obstruction resolution.
• Better fertility results (with the chosen patients)
• Increased motion and performance of the organs.

Adhesiolysis surgery

Adhesiolysis is a procedure that is used to cut and release adhesions or bands of scar tissue that abnormally bind together organs. Usually, it is done when a patient has abdominal or pelvic adhesions causing pain, bowel obstruction, infertility, or limitation of function.

Preparation before the operation

• Detailed history and examination.
• Imaging (CT, MRI, US) if bowel obstruction or complex adhesions suspected.
• Anaesthesia evaluation and blood tests. 
• Bowel preparation (in case of chosen intestinal cases)
• Preoperative starvation 68 hours.
• Risk and benefits informed consent.

Adhesiolysis Procedure 

Anaesthesia

• Surgical intervention on general anaesthesia.

Surgical Access

Laparoscopic approach:

• Little holes are opened, and trocars are placed. An abdomen is inflated using carbon dioxide gas.

Open approach:

• An incision is done once on the abdomen or at the pelvis but bigger.

Exploration

• The surgeon examines the abdominal or pelvic cavity meticulously in order to detect adhesions and the organs involved (bowel, uterus, ovaries, bladder).

Adhesion Separation

Dissection of adhesions is done with:

• Fine scissors
• Electrocautery and ultrasonic scalpel, both electrical devices for tissue cutting and coagulation) 
• Occasionally laser tools
• The process of separation is done with caution in order to prevent injuries to organs and blood vessels.

Hemostasis

• The bleeding is managed as soon as possible to avoid the formation of adhesion.

Organ Assessment

• The liberated organs are checked to make sure that blood supply and functioning are normal.
• Bowel viability is determined in case intestinal adhesions had occurred.

Adhesion Supporting Measures

• In some instances, the use of anti-adhesion barriers or gels can be used.
• Minimal cautery and gentle tissue manipulation minimise chances of recurrence.

Closure

• Instruments are removed.
• The incisions are closed with staples or sutures.

Operating Time

• Laparoscopic: 45 to 2 hours.
• Open: 1-3 hours or even more in complicated cases.

Post-operative Care

• Early mobilization and pain management.
• Progressive reintroduction to oral feeding.
• Seeing the bowels mobilize and wounds heal. 

Laparoscopic adhesiolysis

Laparoscopic adhesiolysis – is a procedure with which Laparoscopic (KEY HOLE) surgeon separates and removes the adhesions (fibrous bands of scar tissue) between the organs in the abdominal or pelvic cavities. These post-operative adhesions may occur after surgery, infection, inflammation or trauma and can cause chronic pain, bowel obstruction, infertility or organ dysfunction. 

Indications

Laparoscopic adhesiolysis is recommended if your adhesions lead to: 

• Severe and chronic abdominal or pelvic pain that is not relieved by medical treatments.
• The partial or complete bowel obstruction, which is recurrent.
• Female infertility and pelvic adhesions.
• Complications of repeat abdo/gynae surgery.

Laparoscopic Adhesiolysis Surgery 

Anaesthesia

• It was performed under general anaesthesia.

Port Placement

• The cuts made in the belly are tiny (5-10 mm). 
• The laparoscope (camera) and instruments are inserted. 
• Inflation of the abdomen is done with the help of carbon dioxide gas to achieve a better view.

Adhesion Identification

• The surgeon continuously inspects the abdominal or pelvic cavity.
• Identify adhesions of the bowel, uterus, ovaries, bladder, and abdominal wall. 

Adhesion Dissection

To divide adhesions, the following are used:

• Fine laparoscopic scissors
• Ultrasonic energy devices
• Minimal Electrocautery.
• Acute dissection is the one that is wanted in order to minimize tissue damage.

Organ Protection

• Constant visualization to avoid injury.
• Soft tissue handling so as to conserve blood flow.

Adhesion Prevention

• Anti-adhesive agents or gels can be used.
• Limited blood loss and precautious irrigation minimize the risk of recurrence.

Closure

• Carbon dioxide is released
• Instruments are removed
• Small cuts are repaired using sutures or skin glue.

Surgery Time

• Normally, 45 minutes to 2 hours depending on the severity of the adhesion.

Post Laparoscopic Adhesiolysis Recovery

• Hospital stay: 1–3 days
• Pain: Mild to moderate, and controlled by oral medication.
• Diet: Liquids then soft diet and then normal diet when bowel action is normal again.
• Rest to normalcy: 7- 14 days.
• Full recovery: 2–3 weeks

Laparoscopic Adhesiolysis Advantages

• Smaller incisions
• Less postoperative pain
• Faster recovery
• Reduced stem of new adhesions as compared to open surgery.
• Shorter hospital stay

Adhesiolysis recovery

The outcome of adhesiolysis is based on the type of surgery (open and laparoscopic), type of adhesions and the general health of the patient. Most patients make gradual improvement in pain and function with healing over time. 

Post-operative Recovery (Day 0-2) 

• Ward and recovery room monitoring.
• IV/oral opioid analgesia.
• Early ambulation (walking in 12-24 hours)
• Initially, fluids, followed by slow oral intake.
• Observation of bowel movements, gaseous excretions, and urine.

Hospital Stay

• Adhesiolysis: laparoscopic: 1 -3 days.
• Open adhesiolysis: 4-7 days (or more in case of complications)

First Week After Surgery

• Mild to moderate stomach pain.
• Pain at the shoulders (due to laparoscopy gas) is possible and will disappear in several days.
• Slow resumption of light activities.
• Tolerated soft or normal diet.
• Dressing and changing, as recommended.

Weeks 2–4

• Considerable pain and bloating decrease.
• Better stooling and cramping.
• Go back to office or light duty.
• Do not overstrain the body by lifting heavy, or working hard, or stressing the abdomen.

Weeks 4–6

• Complete recovery of regular performance (previously in laparoscopy)
• Surgical wounds tended to heal completely.
• Enhanced living in case adhesions were presenting symptoms.

Diet During Recovery

• Begin with food that is easy to digest.
• Stay well hydrated
• Gradually the high-fiber foods were introduced (except in cases of bowel surgery).
• First of all avoid foods that produce gas.

Pain Management

• Prescribed oral painkillers.
• Light compresses in case of slight irritation.
• Pain needs to improve gradually; deteriorating pain must be reviewed by a doctor.

Follow-up Care

• 1st follow up visit normally within 7 to 14 days.
• Removal of suture or staples when necessary.
• Follow up of symptom relief and early complications.

Adhesiolysis complications

Although adhesiolysis is commonly successful, it is associated with some risks and complications as the separation of scar tissue and organs in question is rather a sensitive issue. Risk is determined by severity of adhesion, the mode of surgery (laparoscopy and open surgery) and experience of the surgeons.

• Organ Injury
• Bleeding
• Infection
• Recurrence of Adhesions
• Postoperative Ileus
• Hernia Formation
• Complications Related to Anaesthesia
• Conversion to Open Surgery

Best hospital for adhesiolysis India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Adhesiolysis is an operation where surgeons cut through and free up lesions of adhesions, which are tight bands of scar tissue that can lead to pain, bowel obstruction, infertility, or limited organ motion. Alleviates symptoms due to adhesions and normalizes function of the involved organ. Can be laparoscopic (minimally invasive) or open procedure, based on whether the adhesions are simple or complicated. Symptom relief, enhanced fertility (if pelvic adhesions), restoration of bowel and organ mobility, shorter recovery with laparoscopic technique. Organ injury, hemorrhage, infection, postoperative ileus, recurrence of adhesion, or, extremely rarely, fistula and hernia. Usually faster with laparoscopic adhesiolysis, with most patients returning to work in 2-3 weeks. Good postoperative care and gradual resumption of activity is important.

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FAQ

1. When should adhesiolysis be performed?

It is indicated when adhesions lead to:

• Chronic abdominal/pelvic pain
• Bowel obstruction
• Female infertility caused by pelvic adhesions
• Complications during repeat surgeries

2. What is the healing time?

• After laparoscopic surgery most patients can resume their normal activities within 2 to 3 weeks
• Recovery from open surgery may take 4 to 6 weeks for full healing.

3. Can adhesions reform after surgery?

• Yes, adhesions can reform, particularly after open surgery or in patients who have had multiple operations. The risk of recurrence is substantially lower with laparoscopic surgery.

4. How to stop new adhesions from forming?

• Minimally invasive surgery
• Gentle tissue handling
• Apply anti-adhesion barriers or gels
• Avoid unnecessary electrocautery and bleeding

5. Will adhesiolysis pain go away?

• Most patients get great relief of symptoms, but the results are related to the degree of adhesions and the organs involved.