What is Lysis of Adhesions?
Lysis of adhesions is a surgical procedure used to remove or break down internal scar tissue, known as adhesions. The term comes from the Greek word “lysis,” which means to loosen or dissolve, and “adhesions,” referring to the fibrous bands that form between organs or tissues that are not normally connected. Normally, the organs in the abdomen have a smooth, slick coating that allows them to slide freely against one another. Adhesions disrupt this natural movement, causing organs to stick together and potentially leading to a variety of medical problems. The procedure is often referred to by its medical name, adhesiolysis.
What Causes Adhesions?
Adhesions are the body's natural response to inflammation or tissue trauma, a healing process that sometimes goes awry. While not all adhesions cause symptoms, others can become thick, fibrous bands that cause significant complications. The most common causes include:
- Previous Surgery: Abdominal and pelvic surgery are the leading cause of adhesions. A high percentage of patients undergoing such procedures will develop them as a normal part of the healing process. The handling of internal organs, tissue incisions, and the presence of foreign materials like gauze can all trigger adhesion formation.
- Inflammatory Conditions: Chronic inflammatory diseases can also lead to adhesions. Examples include endometriosis, a condition where uterine-like tissue grows outside the uterus, and Crohn's disease, a type of inflammatory bowel disease.
- Infections: Infections within the abdomen or pelvis can trigger an inflammatory response that results in the formation of scar tissue. This includes pelvic inflammatory disease (PID) and appendicitis, especially if the appendix ruptures.
- Radiation Therapy: Exposure to radiation, particularly in the abdominal area, can cause tissue damage and subsequent adhesion formation.
Why is Lysis of Adhesions Performed?
Adhesions can lead to serious health problems, and lysis of adhesions is typically performed when a patient experiences symptoms severe enough to warrant surgical intervention. The primary reasons for the procedure include:
- Chronic Pain: Adhesions can pull on nerves and organs, causing recurring or persistent abdominal and pelvic pain. This chronic discomfort can significantly impact a person's quality of life.
- Intestinal Blockage (Bowel Obstruction): Adhesions can cause kinks or twists in the intestines, preventing food and fluids from passing through. This is a potentially life-threatening condition that requires immediate treatment and is a major reason for adhesiolysis.
- Infertility: In women, pelvic adhesions can attach to the fallopian tubes or ovaries, obstructing the pathway for eggs and leading to fertility issues. Lysis of these adhesions can help restore normal anatomy and function.
- Difficulty with Subsequent Surgery: Extensive adhesions can make future surgical procedures more difficult and risky. Lysis of adhesions may be performed to safely access organs during a planned repeat surgery.
Comparison of Surgical Techniques
The two main surgical approaches for lysis of adhesions are laparoscopic (minimally invasive) and open surgery. The choice of procedure depends on the extent and location of the adhesions, as well as the patient's overall health.
| Feature | Laparoscopic Adhesiolysis (Keyhole Surgery) | Open Adhesiolysis |
|---|---|---|
| Incision Size | 2-4 small incisions | 1 large incision |
| Visualization | Laparoscope (small camera) provides a magnified view on a video screen | Direct view by surgeon through the larger incision |
| Recovery Time | Often shorter, with many patients going home the same day or next | Generally longer, requiring a more extended hospital stay |
| Pain | Typically less post-operative pain due to smaller incisions | Can involve more significant post-operative pain |
| Risk of New Adhesions | Possibly lower, though new adhesions can still form after any surgery | A greater risk of new adhesions forming in the area of the large incision |
| Complexity | Best for less dense, more straightforward adhesions; complex cases may require conversion to open surgery | Required for severe or widespread adhesions, or in emergency situations like a bowel strangulation |
Risks and Potential Complications
While lysis of adhesions can offer significant relief, it carries potential risks. The procedure itself can cause further inflammation and injury, which may lead to the formation of new adhesions. Other complications can include:
- Infection and bleeding: As with any surgery, there is a risk of infection at the incision sites and internal bleeding.
- Damage to organs: The delicate nature of separating internal organs can lead to accidental damage to the bowel or other nearby structures.
- Bowel Obstruction: An ileus, or slowed bowel function, can occur after surgery, causing bloating and constipation.
- Incisional Hernia: A weak area can develop at the incision site, leading to a hernia.
- Recurrence of Adhesions: Unfortunately, new adhesions can form following adhesiolysis, sometimes causing symptoms to return.
The Role of Adhesion Prevention Strategies
Given the risk of new adhesion formation, surgeons often employ preventative strategies to minimize the chances of recurrence. These measures are especially important during gynecological and colorectal surgeries where adhesions are common.
- Meticulous Surgical Technique: Surgeons are trained to minimize tissue trauma, control bleeding meticulously, and prevent tissue from drying out during surgery. These careful steps reduce the inflammatory response that can trigger adhesion formation.
- Adhesion Barriers: Various barriers, often in the form of gels, films, or solutions, can be placed between organs during surgery to physically separate them while the healing process occurs. Products like Adept®, Interceed®, and Seprafilm® have been approved by the FDA for this purpose.
- Hydroflotation: This method involves floating organs in a solution during surgery to keep them separated.
Recovery and Long-Term Outlook
Recovery from lysis of adhesions depends heavily on the surgical approach (laparoscopic vs. open), the location of the adhesions, and the patient's overall health. Patients may experience some pain, bloating, or discomfort initially, which can be managed with medication. A physical therapy regimen may also be necessary to help restore range of motion, especially after orthopedic procedures. The outcome varies, with some patients experiencing complete relief while others may have a recurrence of symptoms or require further intervention. A significant number of patients undergoing laparoscopy for adhesiolysis may see symptom improvement. Compliance with follow-up care and any prescribed rehabilitation is crucial for a successful long-term outcome.
Conclusion
In summary, lysis of adhesions is a surgical treatment to address the complications caused by internal scar tissue. While adhesions are a common outcome of surgeries, infections, or inflammation, they can lead to severe pain, bowel obstructions, or infertility. The procedure, known as adhesiolysis, can be performed using minimally invasive or open techniques to cut or remove these bands of tissue and restore normal organ function. Although effective, it is not without risks, including the possibility of new adhesions forming. Patients should discuss all available options and potential outcomes with their healthcare provider. For more information, the National Center for Biotechnology Information (NCBI) has published extensive reviews on adhesiolysis.
