When do scars make you ill?
Any surgical procedure in the abdominal cavity that involves cutting the peritoneum can lead to the formation of adhesions between the abdominal organs, the abdominal mesh (omentum) or the peritoneum. The peritoneum is the innermost layer of the abdominal wall (peritoneum parietale) and also covers many of the abdominal organs (peritoneum ventrale). After 90% of open abdominal operations, such adhesions usually remain unnoticed, but sometimes lead to abdominal discomfort, infertility, intestinal incarceration with intestinal obstruction and even peritonitis. Adhesions are responsible for small bowel obstruction in about 70% of cases. Up to 40% of female infertility is due to adhesions. These adhesions also make operations using the keyhole technique more difficult, so that operations started using this technique often have to be completed using the open technique.
How do adhesions develop?
Adhesions can be congenital, but they are usually the result of injury to the peritoneum during a surgical or gynecological procedure. Adhesions can also develop after inflammation or as a result of endometriosis. The development process corresponds to wound healing. The body forms a tissue adhesive (fibrin) to heal the peritoneal defect. If the resulting adhesions do not dissolve within a few days, adhesions develop. It has been shown that laparoscopic (buttonhole) surgery reduces the incidence of adhesions compared to open surgery, although this cannot be ruled out. The adhesions can form over a large area or as scar strands (brides).
How are adhesions detected?
Abdominal complaints caused by adhesions are often non-specific. To rule out other causes, it is advisable to carry out examinations such as: Ultrasound of the abdominal organs, colonoscopy and computer tomography (CT). Sometimes these examinations already provide indications of adhesions. Ultimately, however, the suspected diagnosis is only confirmed by laparoscopy. Intestinal obstruction (ileus) caused by adhesions can be diagnosed by a clinical examination and a simple X-ray of the abdomen.
Which forms of therapy do exist?
Adhesions that do not cause any discomfort do not require any treatment, those that cause symptoms can only be treated by surgery - adhesiolysis, dissolution of the nipple. This operation is preferably carried out using the buttonhole technique (minimally invasive), but new adhesions can form afterwards. To prevent this, various measures such as instillation of Icodextrin solution or suturing of PTFE meshes have been carried out. It has recently become possible to apply a PGE (polyethylene glycol) solution in spray form to the areas where the adhesions have been detached. As the adhesions form in the first 5 days after the operation but the PGE substance is only dissolved after 7 days, this can be an effective preventive measure.
Author: Dr. Andreas Franczak
