What are surgical adhesions. Principles of prevention of adhesive disease in the small pelvis

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 band “open” operation.

During laparoscopy, on a thin membrane covering the inner surface of the abdominal wall, damage is formed at the points of passage of instruments, incisions or clips. After the instrument is removed, this section of the damaged membrane (called the serous membrane) heals on its own.

How do adhesions and scars form?

However, our tissues have one natural property that cannot be canceled - they seek to protect our body. And sometimes the development of so-called protective factors after damage occurs intensely - with a margin.

What is the treatment of adhesions after surgery?

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

Adhesions can also connect internal organs to each other. Each of them also covers the serous membrane. During the operation, its micro-tears are not excluded. And these places of microtrauma can also subsequently become a source of 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 ordinary tissue is replaced by a more rigid and inelastic connective tissue. Scars can be on the skin, and may be on the internal organs.

Why are sleepers bad?

Nature took care that in our harmonious body the organs were completed and laid out clearly and correctly, as in Tetris. They occupy the entire interior space and touch each other with suitable sides, like a carefully fitted puzzle. If we consider all the organs separately from the body, one can be amazed at how much space they occupy and how they fit inside us! Precisely because postoperative scars and adhesions violate this original harmony, they affect our body.

What is the negative effect of adhesions. They are:

• disrupt the mobility of the organ, which affects its function. Moreover, both external mobility, which depends on the movements of the diaphragm, and internal mobility, which is active and does not depend on the movement of the diaphragm, suffer;
• disrupt blood circulation in the affected organ;
• violate the innervation of the body;
• 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 these causes lead to other disorders in the body. Moreover, which at first glance are not connected with the affected area. Adhesions and scars that have arisen after abdominal surgery can “radiate” with pain in various parts of the spine, joints, lead to a change in posture and a violation of the position of the body in space, etc.

How are adhesions treated?

According to the timing of the formation of adhesions, there are:

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

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

The doctor may suspect the presence of an adhesive process in the abdominal cavity according to clinical data, the collection of anamnesis and the results of such studies as ultrasound, CT, colonoscopy. The adhesive process in the abdominal cavity and the pelvic cavity can be treated medically or surgically. During the operation, adhesions are separated, but this method should be resorted to only in extreme cases, if the strands are so thick and coarse that they greatly impair the function of the organ, and a more loyal and gentle treatment does not help.

How osteopathy affects adhesions

The 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 pinch. He is also able to loosen their tension in a few sessions, can restore, balance and balance damaged organs, and therefore restore their function to the fullest extent possible.

It is also in the power of the osteopathic doctor to interrupt the chains of damage and pain in the parts of the body that seem to be unrelated to the operated area. After all, our body is a holistic system where everything is interconnected. The osteopath directly affects the adhesion, without violating the integrity of 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 a complete recovery in possible individual conditions for the whole organism.

Any surgical intervention, no matter how minimally sparing it may be, leaves behind a lot of negative changes, injuries and stress that the body has to deal with alone. What the body will undertake for its treatment, what it will sacrifice, how it will limit itself is always individual. But within the framework of self-preservation, this is always expressed in the loss of function to one degree or another, and hence the subsequent suffering of the whole organism with loss of compensation and the expenditure of much greater forces for normal functioning throughout life.

Therefore, if in your life you have had surgical interventions on the abdominal organs, consult an osteopath. 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 osteopath can use pulse diagnostics to determine the significance of adhesions or scars on the body. This means that if the properties of your pulse change when you press on the postoperative scar, then this zone is important and significant for the whole body, and you need to work with this adhesion or scar.

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

• local (the effect is limited to the area where the scar or adhesion is located);
• regional (the influence extends to the entire chest or abdominal region where the spike is located);
• global (affects the entire organism, up to a violation of its position in space).

How long does osteopathic treatment last?

If the patient has undergone surgery, then tactically the osteopath will act as follows. 10 days after the operation, when the sutures are removed, the doctor will work with the scar itself in layers, 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 is within 10 days to 3 months after the operation.

If the duration after the operation 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 sites of the adhesions themselves.

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

During such a minimally invasive operation, there is no wide tissue dissection. Injuries and inflammation are minimized, which does not give rise to the re-formation of adhesions between organs. However, laparoscopy still does not guarantee that the disease will not return after a few months.

To improve the effectiveness of treatment after surgical dissection of adhesions, it is recommended to use active methods of prevention.

6. treatment of the underlying disease;

7. regular visits to the doctor.

Physiotherapy.

• Electrophoresis. During electrophoresis, medicinal substances are introduced into the pelvic cavity under the influence of an electric field. The most effective is the use of drugs containing the enzyme hyaluronidase. It is able not only to inhibit the formation of the connective tissue that makes up the adhesions, but also to loosen the formed formations, increasing their elasticity. The full course consists of 10-15 sessions. This is usually enough to prevent the recurrence of adhesions after laparoscopy.
• Electrical stimulation. Electrical stimulation is the direct effect of weak electrical impulses on tissues. They improve tissue metabolism. Due to this, the fibrin protein formed after the operation will quickly dissolve and will not turn into a dense connective tissue.
• Applications of ozokerite and paraffin. During these procedures, local heating of the pelvic area occurs by exposure to conventional heat. This may somewhat slow down the adhesive process. However, applications are rarely used in the early stages, because in the presence of chronic infections and inflammatory processes, the risk of their exacerbation is high.
• Laser therapy. The procedure is the heating of tissues with the help of directed laser energy. The effect of laser therapy will be more noticeable than with paraffin or ozocerite applications. In the first weeks after surgery, in the absence of complications, laser therapy is the most effective means of prevention.
• Ultrasound. Ultrasound is often used to soften formed adhesions and eliminate pain. Sound waves disrupt microprocesses and the structure of adhesive fibers. This prevents their formation in the first months after the operation.

Massotherapy.

• infectious complications after surgery;
• skin diseases in the abdomen and pelvis;
• oncological diseases.

Physiotherapy.

Osteopathy.

Dieting.

• Increase gas production. These include some fruits and vegetables ( cabbage, pears, cherries), legumes ( beans, peas), carbonated drinks. An increase in intra-intestinal pressure will lead to bloating of the intestines and adhesion of organs in the small pelvis.
• Slow down tissue regeneration. First of all, these products include alcohol.
• Increase the risk of postoperative complications. Such foods are any excessively salty, spicy or fatty foods.

Treatment of the underlying disease.

Regular visits to the doctor.

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Adhesions after surgery

The internal organs of a person are covered with a serous membrane, which allows them to be separated from each other, to change their position during body movements. With the development of a pathological process in one of the organs, the formation of connective tissue often occurs, which glues the serous membranes together, preventing them from moving and functioning properly. In medicine, this condition is called adhesive disease or adhesions, which in 94% of cases develop after surgery. Outwardly, adhesions are similar to a thin plastic film or thick fibrous strips, it all depends on the degree of adhesive disease, as well as the organ in which the pathological process has developed. Adhesions after surgery can appear between almost any internal organs, but most often they develop in the intestines, lungs, between the fallopian tubes, ovaries or heart. What are adhesions, how dangerous are they, and how to treat adhesions after surgery.

What are adhesions after surgery

Normally, after the operation, the internal organ that was submitted to outside intervention should heal, a scar appears on it, and its healing is called an adhesive process, which is a normal physiological process and passes over time without disturbing the work of other organs. The adhesive process has nothing to do with adhesive disease, in which pathological growth and thickening of the connective tissue occurs. In cases where the scars after the operation are more than normal, the internal organ begins to fuse tightly with other organs, preventing them from functioning properly. It is this process that is referred to as adhesive disease, which has its own symptoms and requires additional treatment under the supervision of a doctor.

Adhesions - proliferation of connective tissue

Reasons for the development of adhesions

The appearance of adhesions after surgery largely depends on the professionalism of the surgeon who performed this intervention. A specialist in the field of surgery must have excellent skills in applying sections and sutures, the quality of operating materials and the technical equipment of the clinic itself also matter. Because the quality of the operation depends on it. If there are doubts about the professionalism of the surgeon or there are no ideal conditions in the clinic, then you should look for another hospital or buy the necessary and high-quality materials on your own that will be used during the operation.

Postoperative suture - the cause of the development of adhesions

Probably, each of us heard from various sources that there are cases when, due to the negligence of a doctor or medical staff, some suture materials, tampons, gauze, or some surgical instruments were left inside during the operation. The presence of these factors also contributes to the formation of adhesions after surgery.

Adhesion formation after gynecological operations

Postoperative adhesions are most often formed after surgery on the intestines or pelvic organs. So adhesions after surgery to remove the uterus can form as a result of inflammatory processes or infection. The presence of adhesions after surgery on the reproductive organs often leads to the development of infertility or other disorders. A fairly common cause of the development of adhesive disease after surgery is tissue hypoxia, when the internal organ does not receive enough oxygen. Adhesions after surgery on the organs of the reproductive system are often formed with endometriosis, and in the intestine after surgery for appendicitis, intestinal obstruction or stomach ulcers. Adhesions appear after an abortion, surgery on the ovaries, heart or lungs. Thus, it can be concluded that adhesions after surgery can appear for many reasons, but in any case they cannot be left without due attention of the doctor, since their appearance significantly impairs the functionality of internal organs and often causes complications.

Symptoms of adhesions after surgery

The process of formation of adhesive disease is quite long and directly depends on the organ that was submitted to the surgical intervention. The main symptom of adhesions after surgery is pain in the area of ​​the surgical scar. Initially, there is no pain syndrome, but as the scar thickens, it has a pulling character. Pain is aggravated after physical exertion or other body movements. So after surgery on the liver, pericardium or lungs, pain is felt with a deep breath. If intestinal adhesions after surgery, then pain manifests itself with sudden movements of the body or physical exertion. The presence of adhesions on the pelvic organs causes pain during intercourse. In addition to pain, there are other symptoms of adhesions after surgery, but it is important to note that the clinical picture directly depends on the localization of adhesions and disorders in the body. Consider the most common signs of postoperative adhesions:

• violation of defecation;
• frequent constipation;
• nausea, vomiting;
• complete absence of stool;
• pain on palpation of the postoperative suture;
• redness, swelling of the external scar;
• increase in body temperature;
• labored breathing, shortness of breath.

Pulling pain in the area of ​​the postoperative suture - a symptom of adhesive disease

In cases where adhesions have formed after removal of the uterus or surgery on the ovaries, fallopian tubes or vagina, a woman feels pain during intercourse, pulling pains in the lower abdomen, menstrual irregularities, various discharges from bloody to gray with an unpleasant odor. The formation of adhesions after surgery should be monitored by a doctor, but if they appear several weeks or months after surgery, then the patient needs to seek help on his own.

Possible Complications

Adhesions are a rather complex complication after surgery, which can not only disrupt the functioning of internal organs, but also provoke complications, including:

• acute intestinal obstruction;
• necrosis of the intestine;
• peritonitis;
• infertility;
• violation of the menstrual cycle;
• bending of the uterus;
• obstruction of the fallopian tubes;
• ectopic pregnancy.

Complications of adhesive disease

Complications of adhesive disease often require immediate surgical care.

Diagnosis of the disease

If you suspect the presence of postoperative adhesions, the doctor prescribes a series of laboratory and instrumental examinations to the patient:

• A clinical blood test will show the presence or absence of an inflammatory process in the body.
• Ultrasound examination (ultrasound) - visualizes the presence of adhesions.
• X-ray of the intestine.
• Diagnostic laparoscopy.

The results of the research allow the doctor to determine the presence of adhesions, consider their shape, thickness, determine how the internal organs work, and prescribe the necessary treatment.

Treatment of adhesions after surgery

Treatment of adhesions directly depends on the state of health of the patient. In order to reduce the development of adhesive disease, the doctor in the postoperative period prescribes anti-inflammatory drugs, various enzymes for resorption of adhesions, less often antibiotics, and also advises to move more, which will prevent the displacement and “gluing” of the organs together. A good result can be obtained from physiotherapeutic treatment: mud, ozocerite, electrophoresis with medicinal substances and other procedures.

Physiotherapy in the treatment of adhesive disease

In cases where the postoperative period has passed without suspicion of the presence of adhesive disease, but after a while the patient still has large scars, severe symptoms appear, the only correct solution would be to repeat the operation, but to remove the adhesions. Removal of adhesions after surgery is carried out by several methods:

Laparoscopy - the introduction of a fiber optic tube into the abdominal or pelvic cavity with a microscopic camera. During the operation, two small incisions are made, into which a manipulator is inserted with instruments that allow you to dissect adhesions and cauterize bleeding vessels. This method of surgical intervention is less traumatic, since after its implementation there is a minimal risk of complications, and the patient himself can get out of bed already on the 2nd - 3rd day.

Laparoscopy - removal of adhesions

Laparotomy - provides full access to the internal organs. During the operation, an incision of about 15 cm is made. With the help of special equipment, the adhesions are excised and removed. This method of surgical intervention is performed in cases where it is not possible to perform laparoscopy or with a large number of adhesions.

After the operation, the doctor cannot give a 100% guarantee that adhesions do not form again. Therefore, the patient needs to periodically visit a doctor, strictly adhere to his recommendations and carefully monitor his health.

Folk remedies for the treatment of adhesions after surgery

In addition to the conservative and surgical method of treating adhesive disease, many seek help from traditional medicine, which can prevent the growth of adhesions in the early stages. It is important to remember that the treatment of adhesions with alternative methods can only be used as an adjunct therapy to the main treatment. Consider a few recipes:

Recipe 1. For cooking, you need 2 tbsp. Flax seeds, which need to be wrapped in gauze and dipped in boiling water (0.5 l) for 3-5 minutes. Then the gauze with seeds should be cooled and applied to the sore spot for 2 hours.

Recipe 2. You will need dried and well-chopped herb St. John's wort in the amount of 1 tbsp. l. Grass should be poured with 1 cup of boiling water and boiled over low heat for about 15 minutes. After the broth, you need to drain and take ¼ of a glass three times a day.

Treatment of adhesions with St. John's wort

Recipe 3. For cooking, you need aloe, but one that is not less than 3 years old. Aloe leaves should be put in a cold place for 2 days, then chopped, add 5 tablespoons of honey and milk, mix well and take 1 tbsp. 3 times a day.

Recipe 4. You need to take 1 tbsp. milk thistle seeds, pour 200 ml of boiling water, boil for 10 minutes, let cool and strain. The finished broth should be drunk warm, 1 tbsp. l 3 times a day.

Prevention of adhesions after surgery

It is possible to prevent the appearance of postoperative adhesions, but for this, maximum care must be taken both by the doctor during the operation and by the patient himself after the operation. It is very important to follow the doctor's recommendations, move more, follow a diet, avoid physical exertion, and prevent the possibility of infection entering the suture that remained after the operation. If you do not follow all the recommendations, reduce the risk of developing adhesive disease is reduced several times.

Periodic consultation with a doctor in the postoperative period

In addition, if after the operation there are pains in the abdomen, a violation of the stool, vomiting, do not self-medicate, you should immediately call an ambulance. Adhesive disease is a rather serious disease, which in some cases can lead to the death of a person.

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Principles of prevention of adhesive disease in the small pelvis

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 trauma and/or inflammation.

Often, the formation of adhesions does not lead to pathological changes in the abdominal cavity and goes unnoticed. At the same time, their formation during inflammatory processes in the appendages often leads to infertility, and therefore, for example, the prevention of sexually transmitted diseases, or timely and adequate anti-inflammatory therapy, is both 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 mainly as a result of surgical trauma to the peritoneal surfaces and subsequent inflammatory reactions.

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

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 symptomatology is considered as an adhesive disease, which manifests itself:

• acute or chronic forms of adhesive intestinal obstruction;
• violation of the function of the abdominal cavity and small pelvis;
• chronic pelvic pain, or abdominal-pelvic pain syndrome;
• menstrual disorders and tubal-peritoneal infertility (in 40% of cases) in women of reproductive age.

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

All of these factors, and most often their combination, are a trigger that leads to inflammatory processes that cause 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 hysterectomy, and therefore the prevention of adhesions after removal of the uterus is of the greatest importance, compared with other gynecological operations.

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

Methods for the prevention of adhesive disease

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

1. Reduction of damage to the peritoneum due to careful attitude to tissues, reduction (if possible) of the time of the operation, economical use of coagulation techniques and retractors. In addition, it is necessary to reduce the number of sutures and the application of clips, a thorough stop of bleeding without disturbing blood circulation in the tissues, removal of all necrotic tissues and blood accumulations, suppression of infection with low-concentrated antibacterial and antiseptic solutions, moisturizing tissues and washing the abdominal cavity, the use of suture material that does not cause immunological reaction, prevention of glove talc and cotton dust from gauze napkins and tampons getting into the abdominal cavity.
2. Reducing the severity of inflammatory processes through non-hormonal and hormonal anti-inflammatory drugs.
3. Reducing the degree of primary response to aseptic inflammation.
4. Suppression of the cascade of increasing blood coagulability, reducing the activity of fibrin formation and activation of processes aimed at its dissolution.
5. 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).
6. The use of the hydroflotation method, which consists in introducing crystalloid solutions (Ringer's 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.
7. The use of barrier preparations (gels, biodegradable membranes, hyaluronic acid, polyethylene glycol, as well as the introduction of surfactant-like agents, etc.), which are fixed on contact surfaces in the abdominal cavity and in the small pelvis and lead to their mechanical separation.

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

The main advantages of the laparoscopic method in operative gynecology as a method to 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 to prevent the possibility of penetration into the abdominal cavity of ambient air and foreign reactive materials, as well as drying of the serous surface with the destruction of the phospholipid layer;
• the use of bipolar electrodes, which damage tissues much less than monopolar and ultrasonic ones, and prevent the formation of adhesions;
• work on organs and tissues enlarged with an optical camera using tools at a remote distance, which significantly reduces the risk of mechanical injury to the mesothelial layer;
• reduction of manipulations with distant organs and tissues;
• no need to isolate certain areas and floors of the abdominal cavity, for example, the intestines, with surgical napkins;
• more gentle and faster recovery of the anatomical structures and peristaltic function of the intestine;
• the positive effect of laparoscopy itself on the activity of the peritoneum in terms of fibrinolysis (fibrin dissolution).

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

• carbon dioxide injected 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% by volume of oxygen to carbon dioxide significantly reduces these phenomena;
• gas is introduced into the abdominal cavity under pressure;
• dry gas.

Thus, laparoscopic gynecology only slightly reduces the degree of frequency and prevalence of adhesive processes, abdominal-pelvic pain syndrome and the frequency of repeated operations associated with adhesive disease. Laparoscopic techniques are not a reason to abandon the basic principles of adhesion prevention. The choice of additional antiadhesion agents depends on the extent of the surgical injury.

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

• restoration of water and electrolyte balance in the body;
• conducting anti-inflammatory and anticoagulant therapy;
• early activation of the patient;
• the fastest possible recovery of bowel function.

The principles for preventing the formation of adhesions are the same for any type of surgical intervention. Their application should be complex and in accordance with the volume and nature of the injury.

How to prevent adhesion formation after surgery

and much more about how to lead a healthy lifestyle

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

The appearance of adhesions

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

Prevention

During operations performed on internal organs, maximum care is taken to prevent foreign material from entering the open wound and avoiding its drying out. If these conditions are not observed, the risk of adhesions increases significantly. Also, their appearance is facilitated by the low mobility of the patient after the operation, so you should start physical activity as soon as possible - this will significantly reduce the risk of adhesions. Be sure to follow the prescribed diet so as not to overload the body. A course of treatment with anti-inflammatory drugs is carried out in order to avoid infections of the internal organs. Immediately after discharge, physiotherapy will be very effective: ultrasound, laser treatment, electrophoresis.

Treatment

If adhesions have already formed or have not been prevented, surgical treatment may be necessary. The most sparing method is laparoscopy: through a small puncture, using a miniature video camera, the adhesive joints are dissected. With a large area of ​​the lesion, it is necessary to make a surgical incision to excise the connective tissue.

You can half try to treat adhesions and folk remedies. For example, this article talks about the folk treatment of fallopian tube adhesions in women.

Effects

Do not neglect the appointment of a doctor after surgery. Refusing postoperative prophylaxis and physiotherapy, the patient may face a number of complications associated with adhesive disease. Incorrect bending or partial narrowing of the intestine, up to obstruction, which may require urgent intervention by the surgeon. In women, adhesions on the internal organs of the small pelvis can lead to the risk of inflammation of the appendages and even infertility.

Very often, after a hospital discharge has occurred, people are in a hurry to quickly return to their daily rhythm of life, work and household chores, without thinking about the risk of complications. In order to preserve further health, you just need to pay attention to yourself, try to organize your daily routine, start eating right and do not forget about physical exercises.

Treatment of adhesions after surgery

Adhesions are connective adhesions between internal organs, having the form of peculiar films, provoked by fibrinogen, a special substance secreted by the human body, which contributes to the healing of wounds. Adhesions can be either congenital or acquired after surgery. The blood or inflammatory fluid, without resolving, gradually, from the 7th to the 21st day, thickens and is replaced by connective tissue. During this time, adhesions from loose, which are easy to treat, become dense, blood capillaries form in them, and after 30 days, nerve fibers are already present in the adhesions.

Causes

More often, the adhesive process is provoked by operations, but other reasons for their appearance are also possible. Adhesions in the peritoneal cavity can remain after bruises or closed injuries of the abdomen, as a result of which the outflow of blood is disturbed, the lining surface of the abdominal cavity “dries up” and the internal organs, in the process of rubbing against each other without a protective “lubrication”, “overgrown” with adhesions. Much less common are cases when adhesions were formed as a result of aseptic inflammation in the abdominal cavity caused by the ingress of certain substances into it, such as alcohol, iodine or a solution of rivanol. By the way, these fluids can enter the peritoneum only during the operation.

Symptoms

As a rule, the entire adhesive process as such goes unnoticed. All the signs by which the presence of adhesions in the body can be diagnosed relate to the complications they cause. Therefore, the symptoms are quite diverse and depend on the localization of adhesions and the disorders provoked by them.

Symptoms of abdominal adhesions:

• Low pressure;
• Sharp sharp pain;
• Temperature increase;
• General weakness;
• Constipation.

The adhesive process in the intestine has similar symptoms and is much more difficult to diagnose. If treatment is not started on time, adhesions in the intestines can even degenerate into a malignant tumor. The most common symptoms of intestinal adhesions are constipation with occasional pain, pain during exercise, and weight loss.

When the process is running, the symptoms are already the following:

• Intestinal spasms;
• Vomiting with admixture of feces;
• Bloating of the intestines;
• Temperature increase;
• pressure drop;
• Strong thirst;
• Drowsiness, weakness.

1. Spikes in the lungs reveal themselves as pains when breathing, aggravated "by the weather."
2. The adhesive process on the liver gives pain on inspiration.
3. Adhesions on the uterus cause pain during sexual contact.

Treatment Methods

Treatment of adhesions depends not only on the physical condition of the patient, but also on the manifestations of the disease itself. Since the main cause of adhesions is surgery, treatment should be therapeutic. Surgical methods for removing adhesions are used only in the most extreme cases when the life of the patient is threatened.

At the first stages of the adhesive process, aloe preparations, vitamins E and folic acid are used. True, these funds can only stop the development of new adhesions and make existing ones more elastic.

It is customary to treat the adhesive process with physiotherapeutic methods, such as:

• paraffin applications;
• ozocerite applications;
• electrophoresis with absorbable and analgesic drugs (calcium, magnesium or novocaine);
• enzyme therapy;
• laser or magnetic therapy;
• massage.

With all of the above, there are indications for surgical intervention to get rid of the adhesive process. Laparoscopic surgery is prescribed for acute adhesions (usually it becomes necessary for intestinal obstruction, when the attack cannot be removed within 1-2 hours). Laparoscopy is also performed with obstruction of the fallopian tubes.

The actual treatment by laparoscopy includes the dissection of adhesions using an electric knife, laser or under water pressure. To prevent the re-formation of adhesions in the postoperative period, special preventive procedures are prescribed.

Home Recipes to Treat Adhesions

Treatment of adhesions with home methods, herbal teas, lotions is very effective, it is especially good to use them in the postoperative period to prevent the adhesive process. Pharmacies offer a very wide range of herbal medicines, but they are easy to prepare at home.

• Tea against pulmonary adhesions: 2 tbsp. l. rosehip and nettle, 1 tbsp. l. combine lingonberries. Add to 1 tbsp. l. mixes 1 tbsp. boiled water and leave for about 2-3 hours. Drink half a glass in the morning and evening.
• Linen lotion: 2 tbsp. l. place flax seeds in a cloth bag and dip in boiling water. Cool down in water. Make lotions on the places of adhesions at night.
• Decoction of St. John's wort: In Art. l. St. John's wort add a glass of fresh boiling water, boil for 15 minutes. Drink 1/4 tbsp. 3 times a day.
• Herbal tea: Prepare a mixture of sweet clover, coltsfoot and centaury. In Art. l. mix pour about 200 g of boiling water and leave in a thermos for 1.5 hours. Drink for a month on an empty stomach for 1/4 tbsp. 5 times a day.

Treatment of adhesions with massage at home is possible only after consulting a doctor, otherwise, instead of a cure, you can get a hernia. It is better to stick a strip of foil in place of the scar with adhesive tape.

Prevention of the adhesive process

Adhesion prevention methods aimed at reducing tissue damage during surgical operations can be divided into two main groups.

They include mainly the prevention of foreign objects, such as dressings, from entering the abdominal cavity, and careful debridement of the operating space. In addition, a scrupulous stop of bleeding and the use of appropriate antibacterial drugs are necessary.

To prevent the appearance of adhesions, the following drugs should be used:

To create a barrier between the internal organs, specialists use various chemicals, including anti-inflammatory and antihistamines.

Immediately after the operation, physiotherapy, such as electrophoresis with lidase, is very effective.

These are the methods of prevention that should be used by physicians. What can the patient do to avoid the occurrence of adhesions after surgery?

First of all, it is very important not to stay too long in the postoperative period, to start restoring physical activity as soon as possible.

Be sure to follow a diet - eat a little, but often. Foods that can cause increased gas formation should be excluded from the menu - grapes, cabbage, fresh black bread, beans, apples.

Treat constipation in time, the stool should be regular. Limit your physical activity, in particular, never lift a load weighing more than 5 kilograms.

Usually adhesions do not cause any special complications and they do not need to be treated. But, nevertheless, we should not forget that the human body is not just a set of organs that each perform its own function, it is their interconnected complex. Violations in the work of one system will necessarily entail the development of pathological processes in another. For example, many appendix surgeries give an 80% chance that the patient will have to treat the gallbladder in the future.

Are adhesions after surgery a problem for those who have undergone abdominal or pelvic surgery? This problem still remains relevant in surgery, since there are a huge number of methods for preventing the appearance of new adhesions and treating already formed ones. However, despite all efforts, often after extensive surgical interventions, the process of adhesion formation continues to develop. This is largely determined by the characteristics of the human body and the nature of the intervention. However, even after the appearance of postoperative adhesions, the intestines can be treated, reducing the symptoms of the disease.

What causes spikes?

Adhesive disease is a condition that occurs when a large number of individual adhesions are formed or a significantly pronounced adhesive process is formed, which leads to disruption of the functioning of internal organs.

In most cases, intestinal adhesions occur after surgical interventions. Most often they appear after major operations performed by laparotomy (through a large incision in the abdominal wall).

At the dawn of surgery, doctors who operated at the dawn of surgery noticed that, if repeated operations were necessary, adhesions between individual organs were found in the abdominal cavity. Even then, it was clear to surgeons that the numerous complaints that patients make after surgical interventions on the abdominal organs are associated with adhesions. Since then, a complex history of studying this problem has begun.

The adhesive process (adhesion of the intestines) is currently one of the most studied pathological processes in the human body. The main reactions of the internal environment, which play a decisive role in the occurrence of adhesions, include:

• inflammatory response of tissues;
• coagulation of blood and proteins contained in it;
• anti-clotting.

During surgery, trauma to the peritoneum is inevitable. In the event that only one of its leaves was damaged, and the one with which it is in contact remained intact, no adhesion is formed. But even if such an injury caused the fusion between the organs, it will be superficial, easily exfoliated and will not lead to impaired organ function.

If 2 adjacent sheets were injured, then a whole cascade of pathological reactions is triggered. Due to the violation of the integrity of the blood capillaries, the release of individual blood proteins occurs. Globulins (namely, clotting factors) play a major role in organ adhesion. When these proteins come into contact with exposed intestinal tissue, a cascade of coagulation reactions is triggered. The outcome of this cascade is the precipitation of fibrinogen in the form of fibrin. This substance is the universal "glue" of our body, which leads to the formation of early intestinal adhesions after surgery.

In the process of blood coagulation, a significant role is played by the anticoagulant system, which is activated somewhat later than the coagulation system. In most cases, the blood that has fallen on the peritoneum of the intestinal loops first coagulates, and then again passes into the liquid phase precisely due to the fibrinolysis system (dissolution of precipitated fibrin). But sometimes, upon contact with the peritoneum, this process can be disturbed, and fibrin does not dissolve. In this case, saiqi may appear.

Symptoms after surgery

In most cases, the resulting adhesions are small and do not actually affect the functioning of the internal organs. However, in the case when the deformation of the structure occurs, symptoms of adhesions occur. The clinic depends both on the size and on the localization of the pathological process. The most common symptoms of the adhesive process include:

Pain in the abdomen is the main manifestation of adhesive disease. The cause of the pain is a serious violation of the functioning of the intestine. The nature of the pain can also vary from patient to patient. In some it is permanent, in others it is convulsive. A feature of pain receptors in the intestinal wall is their increased sensitivity to stretching. Therefore, physiological bowel movements (peristalsis) can lead to significant bowel tension and provoke pain.

This is also the cause of pain after eating certain foods, which contributes to increased gas formation or increased peristaltic movements of the intestine. Separately, it is worth mentioning the pain, which increases with physical exertion.

More often it occurs when the adhesion is located between the loops of the intestine and the anterior abdominal wall. Due to the contraction of the muscles of the abdominal press, there is tension in the intestinal tissue and its mesentery. With excessive physical exertion, this can lead to the formation of obstruction. The appearance of discomfort is due to approximately the same reasons as pain.

Diagnosis of adhesions is based on the collection of numerous complaints. Some patients may not experience pain or discomfort at all. But constant constipation and the presence of a large abdominal operation in the past should lead to the idea of ​​an adhesive process. Stool disorders occur due to chronic damage to the intestinal wall and a decrease in motor activity. The consequence of such changes is a slowdown in the movement of chyme along the intestinal tube. In the future, the process of the final formation of fecal masses and a decrease in the frequency of fecal excretion are delayed.

General manifestations of the disease

Intestinal adhesions are manifested by symptoms - both local and general. These include constant weakness, a number of mental disorders and reduced immunity. There are several reasons for these manifestations:

1. Constant pain and discomfort in the abdomen lead to exhaustion of the nervous system and form the so-called "core" of psychological changes in consciousness.
2. Violation of normal intestinal motility leads to a decrease in the supply of nutrients to the bloodstream.
3. Long-term presence of feces in the large intestine contributes to increased reproduction of microorganisms in its lumen.

The occurrence of pain both during movements, physical exertion, and at rest contributes to the formation of protective behavior. It manifests itself in the fact that the patient tries to avoid a certain movement, posture or behavior. Accordingly, the normal spectrum of activity is limited. This may affect the scope of professional activity, which ultimately leads to some withdrawal from social contacts.

In addition, a belief is formed in the mind that this condition is caused by the actions of medical personnel, so in the future it is worth avoiding seeking medical help. All this in combination leads to a delay in proper assistance and aggravation of the condition.

Adhesions in the abdomen, disrupting intestinal motility and reducing the absorption of nutrients, are mainly associated with a violation of the nutritional status of a person. There is a chronic insufficiency of proteins, fats and carbohydrates. The result is weight loss and a decrease in immune status. However, this is not typical for all individuals who have developed adhesions as a result of the operation. The addition of beriberi significantly complicates the course of the underlying disease and may contribute to the addition of secondary bacterial complications.

Why are spikes dangerous?

In addition to malnutrition, vitamin deficiencies and mental disorders that develop over the years, it is possible to complicate the course of the adhesive process with severe and often life-threatening conditions:

• acute intestinal obstruction.
• intestinal necrosis.

Acute intestinal obstruction develops when the adhesion deforms the intestine so much that its patency virtually disappears completely. In this case, there is an acute cramping pain in the abdomen. A fairly clear localization of pain at the site of obstruction is possible. This pain is easily distinguished from the usual course of the disease, which is associated with its severity and suddenness, and not with any movement or position of the body.

Vomiting joins very quickly. Initially, the vomit has signs of previously eaten food, but after a while, bile impurities appear. And if left untreated, vomit becomes fecal (since the contents of the intestine can no longer move in a physiological direction). Rarely, blood appears in the stool. Common manifestations include the following:

• in the first place is a pronounced general weakness;
• body temperature rises;
• the facial features of the patient are sharpened;
• the skin takes on a gray tint;
• eyes sink;
• in the absence of emergency surgical care, death occurs within a few days.

No less serious complication is necrosis of the intestine. In the pathogenesis of this condition, there is tissue clamping of the commissure of blood vessels and a violation of blood flow in the intestinal area with the development of ischemia (oxygen starvation), and later tissue death.

The main manifestation is increased abdominal pain and severe bloating. May join vomiting. The temperature rises significantly, chills appear. Due to the violation of the barrier functions of the intestine, microorganisms gain access to the systemic circulation. As a result, sepsis develops, which requires urgent medical intervention. Otherwise, within a few hours or days, death will occur.

How to remove adhesions, treatment methods

Treatment of adhesions after surgery is a serious, lengthy and controversial issue. The occurrence of complications is an absolute indication for surgical treatment. At the moment, for this purpose, numerous techniques are used: starting with the intersection of individual elements of the adhesive tissue (in the absence of necrosis in the intestinal wall) and ending with the excision of a section of the intestine that has undergone necrotic changes.

If the issue of surgical treatment of adhesive bowel disease is resolved, then a full and comprehensive preparation of the patient for surgical intervention is necessary, aimed at correcting the disturbed metabolic links and compensating for all concomitant diseases. The goal of the surgeon is to remove as much of the connective tissue that forms adhesions as possible. However, this procedure is exclusively temporary, because. even after the removal of adhesions, there are areas of tissue that can later “stick together” again, and the symptoms of adhesive disease return.

There are many controversial opinions about how to treat adhesions formed after surgery in a conservative way (without surgery). However, all experts agree that a radical cure is possible only by removing the adhesions themselves. The attending physician can offer a number of techniques that, as a rule, will alleviate the patient's condition, but will not get rid of the cause. These include:

• diet food;
• periodic forced bowel cleansing;
• symptomatic drug treatment.

The peculiarity of nutrition is to eat food during the day in small portions, but often. It is necessary to avoid foods that increase the formation of gases (legumes, foods containing a significant amount of fiber).

Under the forced cleansing of the intestine means the conduct of cleansing enemas. This procedure should be carried out as needed, but not more than 3 times a week. The drugs that can reduce the manifestations of the disease include antispasmodics (No-shpa and its analogues), painkillers (Ketanov, Fanigan).

Prevention of adhesions after surgery

Most patients are interested in how to avoid adhesions and prevent the development of pathology. Recommendations in this regard apply to both the doctor and the patient. Timely seeking medical help depends on the patient in order to prevent the development of complications that significantly aggravate the course of surgical pathology. In some cases, timely prescribed conservative treatment can have a sufficient effect, and surgery is not required.

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

Collapse

The concept of adhesions

Adhesions are an additional tissue, a feature of which is the sticky fibrin secreted by it. Because of this, this tissue glues organs together. This is due to the protective reaction of the body, that is, the growth of adhesions is necessary to maintain a diseased organ or tissues affected by the inflammatory process.

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

Reasons for the formation of adhesions after removal of the uterus

The formation of adhesions after removal of the uterus is a frequent occurrence, since the wound healing process is accompanied by the formation of a connecting scar. The space that has been formed begins to overgrow. The main cause of the adhesive process is the individual feature of the body, in which it does not produce the enzyme responsible for the resorption of fibrin overlays.

The causative factors of this pathological condition are:

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

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

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

How long does it take for adhesions to form?

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

Symptoms and signs

In most cases, the presence of adhesions is not manifested in any way. Symptoms appear even when the situation worsens.

The main symptoms include bowel dysfunction. Namely, intestinal obstruction, which is manifested by a pathologically rare defecation or a complete cessation of fecal discharge. Constipation and flatulence are also observed.

Additionally, there will be the following symptoms:

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

Diagnostics

Diagnosis of the adhesive process is difficult, since the formulation of an accurate verdict is possible only after laparoscopy or a full-fledged abdominal operation. But the doctor can suspect the presence of adhesions after such diagnostic methods:

• Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
• Ultrasound of the abdominal cavity and small pelvis allows you to assess the location of organs. The doctor may assume that there is a connective tissue lesion, as the organs will not be located correctly.
• Diagnostic laparoscopy is a minimally invasive method that allows using a special manipulator to fully visualize organs and other structures.

With the formation of adhesions after surgery to remove the uterus, an X-ray examination of the intestine is sometimes prescribed, especially if there is a complex of symptoms of organ dysfunction. In this case, contrast agents are used. As a result, it is clear how narrow the intestinal lumen is and what degree of intestinal patency.

The danger of adhesions

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

Dangerous complications are:

• acute intestinal obstruction;
• necrotic lesion of the intestine;
• peritonitis.

Treatment

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

Physiotherapy has also proven to be effective. They are used both to prevent the manifestation of adhesions, and already in their presence.

Physiotherapy

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

In addition, paraffin and ozocerite applications are used. To date, laser therapy and magnetotherapy are popular methods of treatment.

Enzyme preparations

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

• Urokinase - breaks down blood clots by dissolving them.
• Fibrinolysis - this substance is able to dissolve fibrin.
• Chemotrypsin is a drug that helps thin viscous exudate and thickened blood. The active substance breaks down fibrous deposits and necrotic tissues.
• Hyaluronidase (Lidase) - this drug contains hyaluronic acid in its composition. The action is aimed at softening scars, as well as for the treatment of hematomas.
• Streptokinase - this tool is able to dissolve blood clots, or rather, dissolve fibrin in blood clots.
• Trypsin.

Laparoscopy

Laparoscopy is a surgical treatment related to minimally invasive interventions. This method consists in the doctor making several small incisions through which instruments and a manipulator are inserted. During the operation, the adhesions are dissected and the vessels are cauterized. Also, the doctor must remove the synechia. This is done with a laser, aquadissection, or electrosurgery.

A positive factor in such treatment is the minimum list of complications, which, moreover, are extremely rare. Also, rehabilitation after laparoscopy does not last long. The very next day after this operation, the woman can get up. The recovery period is not longer than a few days.

Strip surgery to remove adhesions is called a laparotomy.

Prevention

The main prevention of adhesions is the correct treatment of the surgical type, without any violations, since adhesions form after operations. Also, the manifestation of strands can be affected by incorrect rehabilitation methods. How to avoid adhesions? Doctors recommend after the intervention to remove the uterus:

• Follow a diet.
• Properly care for the postoperative suture so that there is no infection of the wound.
• Do not allow excessive physical exertion, but you need to move more.

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

Conclusion

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

Adhesive disease is the appearance of adhesions after surgery (areas of fibrous tissue) that form between the mucosa of the inner wall of the abdominal shell (parietal peritoneum) and the loops of the small and large intestines or other organs of the abdominal cavity: gallbladder, liver, bladder, ovaries, uterus.

In the normal state, the organs of the abdominal cavity and their walls are covered with a slippery peritoneum, which prevents them from sticking to each other. Adhesions appear after interventions in organ tissues. Symptoms of postoperative adhesions will depend on their number and location. Adhesions can only be treated surgically.

How do adhesions hurt and what causes them?

The most common cause of the formation of adhesions are operations on the abdominal organs. Virtually everyone patients (about 95%) after surgical interventions on the abdominal organs develop adhesive disease.

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

Reasons for the formation of adhesions during operations:

In rare cases caused by inflammation, the appearance of which is not associated with the operation.

These reasons include:

• Performing radiotherapy for the treatment of cancer.
• Appendicitis.
• Infectious diseases of the internal organs of the abdominal cavity.
• Gynecological diseases, for example, adhesions after removal of the uterus.
• Adhesions after laparoscopy.

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

The mechanism of the appearance of adhesions

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

During damage to the tissues of the abdominal cavity, an inflammation process appears, in the area of ​​\u200b\u200bwhich occurs connective fibrous tissue from which seals are formed. With the development of adhesions, the intestine will no longer be able to move freely in the abdominal cavity, since its loops are connected to each other, to the abdominal wall or to other organs of the abdomen.

In areas of adhesion formation, the intestines can twist around the axis, because of this, the normal passage of food or blood supply is disturbed. Often it happens in the small intestine. Twisting is usually temporary, but in some cases it may not spontaneously recover.

Spikes: Symptoms of the appearance

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

With adhesive disease, abdominal pain appears as a result of nerve tension inside the adhesions themselves or in the abdominal organs.

Symptoms of the adhesive process in the abdominal cavity:

Bowel obstruction, which is caused by adhesive disease, may require emergency surgery. Intestinal adhesions can cause spasmodic, undulating pain in the abdomen that may last for several seconds and worsen after eating, as it increases the activity of the digestive system.

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

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

• Constant and severe pain.
• Severe distension of the intestines.
• Disappearance of defecation and discharge of gases.
• The disappearance of the sounds of intestinal peristalsis.
• A strong increase in body temperature.
• The abdomen increases in size.

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

Adhesions during removal of the uterus

When the uterus is removed, the symptoms of the appearance of adhesions in the female body are diverse, since this is quite complex surgery. In gynecology, postoperative female adhesions occur in most patients. The appearance of adhesive processes is due to many factors:

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

Diagnosis

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

How to treat adhesions?

Adhesions that do not cause complaints do not need any treatment. There are no conservative treatments for adhesions.

Treatment of adhesive disease will depend on the degree of formation and location of adhesions and the causes of occurrence. Often, the patient does not have any pain, and the condition improves without surgery. Before the development of this disease, doctors prescribe symptomatic treatment.

Surgical treatment

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

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

Most often, they try not to use a second surgical intervention, since this is characterized by the risk of new adhesions.

How to treat adhesions in a folk way?

There are many different folk methods that are used for adhesive disease. But in their research safety and efficiency have not been studied, therefore, before using these methods, you should consult a doctor.

Castor oil

Relieves inflammation and pain, and with continued use may reduce scar tissue. It is necessary to soak several layers of castor oil woolen or cotton fabric, place it on the stomach where it hurts. Wrap the fabric with cling film and fix it with something, tying the waist. After applying a hot heating pad to this place. Due to this heat, castor oil penetrates the skin. Keep this bandage for 2 hours, then remove. These compresses must be done every other day.

Healing herbs

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

Tea from calendula and comfrey:

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

Add herbs to boiled water. Let it brew for about 20 minutes and decant. If necessary, add honey. Consume every day.

Oil from calendula and comfrey:

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

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

Twice a day, gently rub this oil into the stomach. This must be done regularly, over several weeks. We must not forget that before using any traditional medicine, you should consult a doctor.

Diet

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

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

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

Also, the doctor may allow the use of refined flour baked goods, refined white rice, crackers, low-fat broths and soups, cereals, fish, tender poultry meat. Also, a slag-free diet for adhesive disease can limit sour-milk products.

Disease prevention

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

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

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

• Careful touch to organs and tissues.
• Use of gloves without talc and latex.
• The use of saline to moisturize organs and tissues.
• Use of wet wipes and tampons.
• Reducing the duration of surgery.

The appearance of an adhesive process after surgical interventions on the abdominal organs is a fairly common occurrence. Most often, this does not cause any symptoms and does not pose a danger to the life of the patient. But in some cases adhesive disease can be the cause of a bright symptomatic picture of intestinal obstruction, which requires surgical intervention to eliminate.

Artur 15.03.2018

Hello. Is there a high probability of formation of adhesions after inguinal hernia surgery using the Liechtenstein method (mesh)? Is it possible to say that in 95% of cases adhesions appear? Thank you.