Adhesions are one of the best hidden secrets or enigmas of modern medicine The word adhere literally means to stick or to bind together. When tissue that is normally not connected grows together, it is called an adhesion. It is also commonly referred to as scar tissue. Adhesions are fibrous tissues (scar tissue) that cause [...]
Adhesions are a widespread problem and develop following any type of pelvic or abdominal surgery. The rate of adhesion formation after surgery is surprising given the relative lack of knowledge about adhesions among doctors and patients alike. Adhesions have been shown to develop in up to 93% of surgical patients. This number increased in patients with major and multiple procedures respectively. Similarly, some studies found that 93% of patients who had undergone at least one previous abdominal operation had adhesions, compared with only 10.4% of patients who had never had a previous abdominal operation. The incidence of adhesions has increased with the rise in gynaecological procedures. It has been shown that between 60 to 90 % of women suffer post operative adhesions following major gynaecological surgery
Rarely adhesions are present from birth. Adhesions commonly form in the abdominal-pelvic cavity as a result of inflammation, injury or following surgery – as part of the body’s completely natural and normal healing process. Usually they occur as part of the healing that takes place after surgery, particularly abdominal surgery. Adhesions can also form after inflammation in the abdomen or pelvis. Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, trauma, or radiation. Repair cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself, or another organ, scar tissue may form to connect the 2 surfaces.
The Impact of Adhesions on Patients:
•Adhesive Disease accounts for 49-74% of small bowel obstructions.
•Adhesive Disease accounts for 15-20% of infertility cases.
•Adhesive Disease accounts for 20-50% of chronic pelvic pain cases.
•Reduced quality of life.
•Loss of work days and productivity
•Increased risk, complexity and complications during subsequent surgery.
•One study showed a 19% rate of adhesion-related bowel perforation during subsequent/secondary operations.
•Bowel perforations occur even more frequently (33%) during surgery for SBO.
•Patients with adhesion-related perforations had significantly higher postoperative complications (leaks, wound infections, hemorrhages and length of stay)
Adhesions may form as the result of the following common gynaecologic procedures: Ovarian Surgery: The ovary is the most common site for adhesions to form, usually resulting from surgery to remove ovarian cysts. Surgical Treatment of Endometriosis: Endometriosis is a disease in which patches of endometrial tissue – the mucous membrane that lines the inside of the uterus – become implanted outside the uterus. Endometriosis often occurs in the pelvis and abdomen and can be associated with severe inflammation and dense adhesions. The abnormal tissue is removed through surgery. Myomectomy Myomectomy is the removal of fibroids from the uterus. Adhesion formation at the incision line on the uterus is a common complication of the procedure. Adhesiolysis Adhesiolysis is the removal or surgical separation of adhesions. Ironically, the removal of adhesions can aggravate the healing process, thereby leading to the formation of new adhesions. Reconstructive Tubal Surgery: The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can lead to the formation of new adhesions. Adhesions also are a common occurrence in women who suffer from pelvic inflammatory disease (PID) and sexually transmitted diseases
Factors that contribute to the cause of adhesions include the following: Trauma: The healing process from surgery is a major contributor to adhesion formation. Ischemia: During surgery, blood flow is often disrupted as a result of tissue cutting, blood clotting or tying of stitches. This may result in ischemia, or reduction of blood flow to the tissues, therefore contributing to adhesion formation. Foreign Bodies: Foreign bodies include stitches, lint from sponges or talc from surgical gloves. Foreign bodies can cause an inflammatory reaction in the body and can trigger adhesion formation. Inflammation: Endometriosis and PID can cause inflammation, which can result in adhesion formation. Adhesions following abdominal surgery Abdominal surgeries that could lead to adhesions include
The tissue develops when the body’s repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation. Although adhesions can occur anywhere, the most common locations are within the abdomen, the pelvis, and the heart. Pelvic adhesions:
Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery.
Adhesions between anterior uterine wall
Adhesions between uterus ,adnexa and bowel posteriorly
Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes.
A woman’s eggs pass through her fallopian tubes into her uterus for reproduction.
Tubal adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops in the tube.
Surgery without any effects…
and which could be very dangerous, especially in adhesions surgery cases!
The next some images show why a surgery without adequate adhesion barriers doesn’t work and therefore is absolute
unnecessary, without any effect and can be dangerous.
This patient has adhesions between sigma / left pelvic wall / uterus / ovar
Adhesion related disorder is a complex of symptoms related to adhesions. Patient’s primary complaint is usually chronic abdominal pain. Their symptoms can be primarily in one area of the abdomen but are often generalized, vague, crampy and difficult to define. The symptoms of ARD could include:
•Chronic pain
•Infertility
•Bowel obstruction
•Gastro-esophageal reflux disease, (GERD)
•Urinary Bladder dysfunction
•Pain and difficulty having a bowel movement
•Pain on movement such as: Walking, sitting or laying in certain positions.
•Loss of Nutrients due to poor eating habits or loss of appetite.
•Loss of employment due to lost work days
•Loss of family and social life
•Emotional Disorders such as: Depression, Thoughts of Suicide, Hopelessness
Other intestinal problems can accompany the pain. Constipation or obstruction is sometimes encountered. Alternating constipation with diarrhea from partial obstruction can also be seen. Symptoms may also be related
Adhesions in the abdomen pull on parts of the intestines and sometimes cause an obstruction. Symptoms may include:
•pain
•cramps
•intermittent vomiting
•difficulty with passing gas or having a bowel movement
•swelling of the abdomen
Symptoms vary depending on the tissues involved. For example, in the gastrointestinal tract, bowel obstructions may occur.
Many women are held captive by a recurring or constant pain in the abdomen. The pain can be intense and sometimes debilitating. It may last for months or even years, leading some women to jump from physician to physician in search of a cure. Chronic pelvic pain is defined as a pain in the pelvic or lower abdomen area, not related to the menstrual cycle, which persists for six months or more.
•When the chronic pain of adhesions is involved, it is very difficult to be diagnosed correctly.
•Diagnostic tests such as blood tests, X-ray procedures, CT scans, MRIs, and Ultrasound will not diagnose adhesions.
•However, your doctor will have to rule out other medical conditions; and depending upon your symptoms, your doctor will order the appropriate diagnostic tests.
•If the results of these tests are normal or negative for abnormal pathology, then a diagnostic laparoscopy may be appropriate.
•A diagnostic laparoscopy is the only test that can confirm the presence of adhesions and/or endometriosis.
•However, a diagnostic laparoscopy can be a “Catch 22 situation”; because surgery itself can cause adhesions to form.
•Doctors typically diagnose adhesions during a surgical procedure such as laparoscopy (putting a camera through a small hole into the stomach to visualize the organs).
•If they find adhesions, doctors usually can release them during the same surgery.
•Studies such as blood tests, x-rays, and CT scans may be useful to determine the extent of an adhesion-related problem.
•However, a diagnosis of adhesions usually is made only during surgery.
•A physician, for example, can diagnose small bowel obstruction but cannot determine if adhesions are the cause without surgery.
Bound By Secrecy? Victims: Bound By Pain! is a triumphant and heartrending story, told with a sense of humor and wit, of a mother trying to find hope and healing for her beloved daughter. It is an inspiring story of perseverance-against all medical odds-and the final triumph over an horrible illness. The writing of Melissa’s trying journey opens the windows of knowledge and ressource to adhesion related disorder, (ARD), forever unmasking this prevalent, yet medically hushed condition.
Why to have Adhesion surgery in Germany ?
Prepared by Roselyn Macdonald, roselyn99@hotmail.com, after having surgery with Dr Kruschinski in late October, 2004.
As you read this information, there are three big advantages that Dr Kruschinski offers any adhesions patient, and which to my knowledge nobody else can, or will, offer. These are precisely and exactly WHY you SHOULD go to Dr K for your surgery and why it is very likely not only to get rid of your pain(s) but also to be the last surgery you’ll ever need for adhesions. As a patient myself who has had 18 years of adhesions and some 5 laparotomies (bad cut from the belly button straight down all the way each time) and some 4 or so laparoscopies with gas, I can tell you this truly. Your post operative pain will be nothing at all like previous surgeries because the spray gel keeps all cut surfaces sliding happily past each other. No ripping and tearing pain such as I had previously thought was ordinary and common (which of course it is for any of you who have not had Dr K’s wonderful work done on you).
The hospital where you will have the surgery and initial recovery stay is a first class hosp
