Adhesions, and what can be done about them

Adhesions, and what can be done about them


Pelvic Adhesions

Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical).

Examples of an inflammatory event would be a tubal infection from a sexually transmitted disease (e.g. Gonorrhea), a post surgery infection, or appendicitis. Chronic "irritation" of the pelvic tissues from a common disease process such as endometriosis, may also incite adhesions. A very significant proportion of symptomatic pelvic adhesive disease arises from previous necessary pelvic surgery ( removal of an ovarian cyst would be a good example).


What are "pelvic adhesions" anyway?? In the process of trying to repair injured tissue, a series of normal healing events may cause some structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal healthy pelvis (or the whole abdominal cavity for that matter) this large space is lined with a tissue called peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In an non-injured or irritated state, the peritoneum can be likened to slippery cellophane wrap…. the organs and structures lying immediately adjacent to each other just slip off each other and do not become bonded together. Given a tissue injury, the healing process initiates a sequence of events that can result in a certain tissue becoming "stuck" to its neighbor, and when this happens certain undesirable results occur.


The ovary for example is a very sensitive structure, much like the testis. If as a consequence of an ovarian cystectomy,( the removal of the cyst from the ovary) the ovary becomes "attached' to the pelvic sidewall, or the top of the vagina, the patient may experience persistent pelvic pain and/or painful intercourse. The diagnosis is suspected by a history of ovarian surgery, and subsequent persistent pain or tenderness unrelated to her menstrual cycle.


After a large abdominal incision (e.g. a hysterectomy for large fibroids) the bowel or an associated fatty structure called the omentum may become adherent to the abdominal wall. Adhesions begin to develop within hours of surgery. If by chance it is a loop of bowel, the patient may experience intermittent bouts of crampy pain, perhaps associated with some nausea, bloating, or even vomiting. The intestinal symptoms are related to some degree of bowel obstruction that inhibits the passage of the bowel contents or gas through the partially obstructed area. When the obstruction is severe then the patient will be very ill with nausea, distention and vomiting, and may not be passing any gas rectally. Xray studies may confirm the severe obstruction, and treatment may require decompression of the bowel by means of a tube passed through the stomach to the intestine, or even exploratory surgery.


More often in my experience, the symptoms are troublesome and annoying, and the obstruction is not severe enough to make any of the Xray tests informative. Often the patient will be sent to the gastroenterologist , and endoscopoic evaluation of both the upper and lower bowel will be performed . Frequently, the diagnosis is "irritable bowel syndrome". It should be remembered that intra-abdominal and pelvic adhesions rarely if ever show up on Xray or ultrasound. Unfortunately, every time an abdominal incision is performed, the risk is present for recurrent adhesion problems. The good news is however that most patients will not develop serious post-operative adhesions causing further problems. Those unfortunate to do so may ultimately undergo repeated surgeries, always hoping that "this will do it!!"


Does everybody develop adhesions?? No they do not, but it is not understood why one person develops very extensive adhesions, and the next individual none at all. The nature of the traumatic tissue event, the duration of the inflammatory insult, the nature of the preceding surgery, the operative technique of the surgeon, and the unknown healing characteristics of a given individual all interplay in the final outcome.

What can be done to minimize pelvic adhesions from forming? Early treatment of an infectious process if identified, utilization of safe sex practices to minimize the transmission of sexually transmitted disease, meticulous surgical technique to minimize unnecessary tissue trauma, and perhaps using barrier products where appropriate. The latter may be helpful in reducing the extent or severity of the post operative adhesion development.


What to do if symptomatic adhesions develop, what are the patients options? The first option in any situation is don't do anything. Pain is a relative experience, and the degree of severity will vary from individual to individual. Minor, or even moderately severe discomfort can often be lived with, or controlled by medication, acupuncture, or medical hypnosis. Not infrequently pelvic pain is not helped by conventional treatment such as hormones, pain medicine, or even surgery. In those circumstances, non-conventional treatment with acupuncture or hypnosis can sometimes be very helpful.

Given significant symptomatic pelvic adhesions being suspected from the history and physical exam, a thorough workup is indicated , which may include special xray studies and ultrasound. Ultimately, laparoscopy may be utilized to allow visual inspection of the intra-abdominal organs. What to do surgically depends on the findings. If an ovary is bound down with adhesions from previous surgery, the extent of the adhesive process may indicate a simple cutting of the adhesions or if necessary, removal of the ovary. If the patient has completed her fertility requirements, and if the pelvic adhesive process is very extensive, a complete hysterectomy with removal of both tubes and ovaries may be indicated. Obviously, the patient and her gynecologist need to have had a very comprehensive and detailed discussion about what might be encountered, and what options might be exercised.


What about abdominal wall adhesions resulting from prior abdominal surgery? These can usually be taken down laparoscopically, thus minimizing tissue injury, as opposed to a conventional large incision. Multiple tiny incisions may be necessary in order for the surgeon to see well, and from different angles the area of dense adhesions. Nonetheless, several tiny 1/2 inch incisions are far less uncomfortable than a conventional laparotomy incision.


If the adhesions are extensive, and the patient has undergone previous adhesion surgery that failed, I have taken an unorthodox approach to such individuals. Because adhesions begin to form almost immediately, along with the healing process involving the raw anterior abdominal wall, I have in special situations recommended a repeat laparoscopy in one week. At this point, the "new" adhesions are flimsy, soft, do not contain a blood supply, and can be swept away with minimal tissue injury, compared to a conventional adhesiolysis (freeing the adhesions surgically) of old adhesions that are dense, very adherent, and bloody. This is performed in an outpatient setting, and usually takes but a few minutes, compared to the time involved dealing with extensive, dense old adhesions.


It is important that patients inquire about their surgeon's experience with extensive adhesions, because what might be viewed as "not possible laparoscopically" by one gynecologist, may be very familiar territory for another. Because bowel may be intimately involved with the adhesive process the patient has to be aware that the worst case scenario may require bowel surgery, and a conventional laparotomy incision.


Pelvic adhesions can be a serious detrimental quality of life issue. Some patients are total pelvic cripples because of this problem. Once formed, they do not disappear with time. If you are suffering from some of the medical complaints outlined earlier, do consider a consultation with an experienced laparoscopic gynecologist and hopefully your adhesive problems can be solved.


J. Glenn Bradley, MD

OBGYN.net Correspondent for Laparoscopy and Hysteroscopy and Alternatives to Hysterectomy Advisory Board Member

http://jglennbradleymd.com/body.cfm?id=7&action=detail&ref=6

DaVinci Robot Peels Grape

Adhesions Related Disorder News you can use ARDvark Blog

Novel Product for Post Surgical Scar Formation Entering Clinical ...PR Newswire (press release), NY - Jan 21, 2009Adhesions are bands of scar tissue that connect anatomic structures that should not normally be connected. These develop when the body's repair mechanisms ...

Feasibility of laparoscopy for small bowel obstruction7thSpace Interactive (press release), NY - Jan 19, 2009The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in ...

Study Finds MRSA In Midwestern Swine, WorkersThe first study documenting methicillin-resistant Staphylococcus aureus (MRSA) in swine and swine workers in the United States has been published by University of Iowa researchers...[read article]

U.S. Government Finds 40% Of People Currently Receiving Long Term Care Are 18-64; Numbers Continue To Rise

Economic Stimulus Bill Mandates Electronic Health Records For Every Citizen Without Opt Out Or Patient Consent Provisions

Discovery Of A Key Protein Regulator Of Inflammation And Cell Death

Flowering Plants Speed Post-surgery Recovery

Research Finds Genetic Connection Between PTSD, Depression And Anxiety

Irritable Bowel Syndrome Can Have Genetic Causes

Increase In C-Section Deliveries Coincides With Increase In Complications During Birth, Study Finds

Tension Free Vaginal Tape Underneath Bladder Base: Does It Prevent Cystocele Recurrence?

Progress Made In Understanding Causes And Treatment Of Endometriosis

Prescription Opioid Abuse, Addiction Less Common Than Many Believe

FDA Approves Fibromyalgia Drug - Savella(TM) (milnacipran HCl), A Selective Serotonin And Norepinephrine Dual Reuptake Inhibitor

Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) - Exclusive Report From 2008 Asian IC Guideline Meeting

Pain Treatment Research Reports Often Cannot Be Trusted

Study First To Pinpoint Why Analgesic Drugs May Be Less Potent In Females Than In Males

Common Treatment For Men's Pelvic Pain Proves Ineffective, Queen's-led Study Shows

Adhesions News

Doctor's advice - Boyfriend pressuring me to smokeJamaica Gleaner, Jamaica - Nov 28, 2008In a lot of young guys, the foreskin is still attached to the head of the organ by little bands of tissue, which are called 'adhesions'. In the teen years, ...

Six Back-Saving Tips for Holiday ShoppersPR Web (press release), WA - Nov 25, 2008The therapy has been shown in peer-reviewed medical journals to reduce adhesions, decrease pain, and restore function. It has proven effective for many ...
Treat golfer's elbow with Graston TechniquePacific Daily News, GU - Nov 24, 2008These adhesions are commonly called knots or myofascial trigger points and can be very painful. I have not examined you, but that spot you press on to ...
Omrix Biopharmaceuticals, Inc. Q3 2008 Earnings Call TranscriptSeeking Alpha, NY - Nov 24, 2008These patients were selected due to the detrimental effect ovarian adhesions can have on a woman's ability to conceive as well as the clinical revenue [ph] ...OMRI
Plant Antioxidant, Lycopene May Protect Germ Cells from Free ...MediNEWS.Direct!, India - Nov 24, 2008Adhesions, fibrous bands formed during the process of healing after surgery, is one of the common causes of tubular dysfunction, which leads to infertility. ...
Student News - Nov. 23Hudson Hub-Times, Ohio - Nov 23, 2008Her research centered on the difficulty of measuring the effectiveness of compounds used in the prevention of adhesions following surgery. ...
Range of motion exercises can prevent frozen shoulderBCLocalNews, Canada - Nov 22, 2008These adhesions cause pain and progressive loss of shoulder motion. Shoulder motion is restricted in a specific pattern, both actively (when you move your ...
Search this blogScienceBlogs - Nov 22, 2008To generate traction the actin is hooked upto these large focal adhesions that line the sides of the membrane and help the cell cling to solids from the ...
Garden Retail Research finds tomato benefitsHorticulture Week, UK - Nov 21, 2008It may also help prevent adhesions in women, where scar tissue causes internal organs to stick together after surgery, according to research at Wayne State ...
Appearance of a Gastrocolic Fistula on Sonography Including Color FlowJournal of Ultrasound in Medicine (subscription) - Nov 20, 2008During the operation, the gastrocolic fistula was not identified because of severe adhesions adjacent to the mass. Accordingly, the surgeon performed ...

Adhesion News ARDvark Blog

Published Date: 08 September 2008
By Joanne Mead
DOCTORS could have saved a woman's life if they had operated sooner, an inquest heard.
Coroner Roger Whittaker recorded this in a narrative verdict at the hearing into the death of Shirley Vernon, 62, on November 30, 2005.She died two weeks after surgery at Calderdale Royal Hospital.
Read More
Milk May Help Bacteria Survive Against Low Levels Of Antibiotics

Superbug Bacteria Use Rattlesnake-Type Poisons To Beat Our Defenses

Recommended Follow-Up Care Lacking In Many Colorectal Cancer Survivors

New Diet Unveiled To Save Millions Of PMS Sufferers

Coated Catheters Reduce Infection Risk

Record $181 Million Grant To Evaluate Health, Poverty And Gender Programs Worldwide, Received By UNC

2008 Da Vinci Awards For Wheelchair Enhancing Ideas - National MS Society Celebrating New Adaptive, Assistive Technologies

Hopeful Medical Industry News On Malpractice Premiums For Physicians Is Released For 2008

Fresh Medical Industry News Reveals Earnings & Productivity Changes For Physicians

New Low Dose Oral Contraceptive YAZ® Launched In Europe

Restech Dx-pH Measurement System Proven To Facilitate Accurate Measurement Of Acid Exposure In Patients With Reflux Related Symptoms

Early Onset Gene For Inflammatory Bowel Diseases Identified

Discovery Of Master Switch In The Brain That Regulates Appetite And Reproduction

ARD Awareness : Adhesion Barrier News

Find out about ARD Before you have any surgery!

Adhesion Barrier News

SprayGel is not approved for sale in the United States.
SprayGel is currently under clinical investigations in the U.S.
http://www.spraygel.com/spraygel/usa_home.htm

After much controversy about its capabilities, Tyco, the new owners of Confluent have re-instituted clinical trials for SprayGel in the U.S.A.

If you are interested in becoming part of the study contact Dr. Alan Johns in Fort Worth, TX.

Baylor All Saints Location:
1325 Pennsylvania, Suite 350Fort Worth, Texas 76104
817-803-6621
Richland Hills Location:3700 Rufe Snow
Fort Worth, Texas 76180
817-803-6625 Email: DAJ@DAJMD.com
_______________________________________

Also Genzyme is requiting for its new product SepraSpray.

Adhesion Prevention

Genzyme has developed a suite of biomaterials used to help improve the outcome of certain types of surgeries. Its Sepra™ line of hyaluronic acid-based products has been clinically shown to reduce the incidence of adhesions following general abdominal and gynecologic surgical procedures. With world-class research and development capabilities, and nearly two decades of experience working with biomaterials, Genzyme is expanding its presence in adhesion prevention through the development of laparascopically applied formulations.Adhesion Prevention publications more >.

In Europe.

Protect yourself from Medical Marketing

See this CNN podcast. It is critical that you consider the steps offered to protect yourself from Medical Marketing.

Who is wooing your doctor?

"Linda Lewis says that when she had back surgery two years ago, her surgeon didn't do what was best for her health; he did was best for his bank account."

Story Highlights

Expert: Research shows that financial ties to drug, device makers influence doctors

Last year, five companies were ordered to disclose payments to physicians

Drugs taken long term are heavily marketed to doctors; short-term drugs less so

Another consideration adhesion patients must face.

FDA Clears ExAblate Fertility Enhancement Study in Women With Uterine Fibroids

TIRAT CARMEL, Israel, May 28 /PRNewswire/ --
- Study Will Compare Birth Rates of Women who Underwent Non-Invasive MRgFUS to Those who had Invasive Fibroid Surgery
InSightec Ltd. announced today that the U.S. Food and Drug Administration (FDA) cleared the company to conduct a clinical trial to evaluate the efficacy and safety of the ExAblate(R) 2000 system utilizing MR-guided Focused Ultrasound Surgery (MRgFUS) for the enhancement of fertility in women with non-hysteroscopically resectable uterine fibroids who are diagnosed with unexplained infertility.
Twenty U.S. and international sites will enroll a total of 650 women with uterine fibroids who are diagnosed with unexplained infertility. Half the women will undergo treatment with the ExAblate system, while the other half will have their fibroids surgically removed.
The study will measure the safety of each procedure, including pregnancy and delivery-related complications. The main efficacy goal of the trial will be to measure which procedure leads to a higher percentage of healthy live births resulting from pregnancies three to 15 months after treatment. Researchers will also examine the cost of treatment and any additional clinically required medical encounters and/or medications outside the study visits.
Read More