Possible causes, dangers, types of diagnosis and treatment of postoperative adhesions. Postoperative adhesions and scars: the importance of rehabilitation in orthopedics

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 has heard from various sources that there are cases when, during the operation, due to the negligence of a doctor or medical staff, some suture materials, tampons, gauze, or some surgical instruments were left inside. 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 a few 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 the resorption of adhesions, less often antibiotics, and also advises to move more, which will prevent displacement and "gluing" of organs to each other. 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 disorders 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, frequent 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 clips, carefully stop bleeding without disturbing blood circulation in the tissues, remove all necrotic tissues and blood accumulations, suppress infection with low-concentrated antibacterial and antiseptic solutions, moisten tissues and wash the abdominal cavity, use 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 clotting, 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.

The reasons

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”, “overgrow” 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 rise;
• 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 rise;
• 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.

Content

Hysterectomy or removal of the uterus is a common operation in modern gynecology. The operation to remove or amputate the uterus is often performed in women after forty years. This is due to the fact that in patients of reproductive age, the removal of the uterus is performed only for serious indications.

Hysterectomy, which involves amputation or removal of the uterus, is performed in the following clinical cases:

• uterine rupture during delivery;
• intensive growth of benign tumors in women after menopause;
• malignant tumors, both of the uterus and appendages, as well as suspicion of an oncological process;
• prolapse of the uterus in the presence of concomitant pathologies.

Sometimes removal of the uterus is performed with extensive injuries in the pelvis and purulent peritonitis, which are characterized by a severe course. The issue of amputation of the uterine body is decided on an individual basis and depends primarily on the severity of the pathologies, the presence of other diseases, the age and reproductive plans of the patient.

Hysterectomy can be performed in several ways.

1. The most common is supravaginal removal or amputation.
2. Extirpation of the uterine body with appendages involves the amputation of both the cervix and both ovaries.
3. Total hysterectomy means the removal of the uterus along with the appendages, cervix, ovaries, local lymph nodes and affected tissues of the vagina. This type of removal is recommended for malignant uterine tumors.

Despite the prevalence of operations to remove the uterus, hysterectomy is recommended for serious indications. This is due to the fact that amputation of the uterus has operational and postoperative complications, as well as long-term consequences that significantly worsen the quality of life of a woman.

Gynecologists note the following operational and postoperative complications.

• Inflammation and suppuration of the postoperative suture. In this case, edema, redness, suppuration of the wound develops with possible symptoms of divergence of postoperative sutures.
• Suture infection after surgery. Symptoms of an infection include high fever and pain. In order to prevent infection, the postoperative suture needs regular treatment.
• Violation of urination. In the early postoperative period, pain often occurs when emptying the bladder.

• Bleeding. This complication can occur both in the operational and postoperative period.
• Damage to neighboring organs. Amputation of the uterine body may damage the walls of the bladder and other organs.
• Pulmonary thromboembolism. This dangerous complication can cause blockage of the pulmonary artery by pieces of torn tissue.
• Paresis of the intestine. Occurs against the background of damage to the nerve fibers of the small pelvis during surgery.
• Peritonitis. This pathology means inflammation that has spread in the abdominal region. If this postoperative complication is not eliminated in time, there is a risk of developing sepsis. In this case, the woman has symptoms such as severe pain, loss of consciousness, earthy skin tone, intense sweating, high fever. Treatment consists of antibiotics and removal of the uterine stump.

Later effects include the following manifestations.

• Loss of reproductive function. Removal of the uterus entails the impossibility of bearing a pregnancy.
• Psycho-emotional disorders. Hormonal fluctuations cause an unstable emotional background, depression, irritability.
• Decreased libido. A woman may notice a lack of sexual desire. Sexual life is characterized by pain and psychological discomfort.
• The onset of symptoms of early menopause. After amputation of the uterine body, symptoms such as sweating, hot flashes, and bone fragility appear.
• The development of the adhesive process. After any surgical intervention, the appearance of adhesions is considered inevitable.
• Cosmetic defect. Since amputation of the uterus occurs most often through abdominal surgery, a noticeable scar remains.

After removal of the uterus by hysterectomy, postoperative adhesions occur, which can lead to unpleasant symptoms, such as pain, defecation and urination disorders, displacement of the pelvic organs, and prolapse of the vaginal walls.

Causes after surgery

Adhesions after amputation of the uterus are one of the most unpleasant consequences of the postoperative period. According to statistics, adhesions after surgery occur in more than 90% of women. The adhesive process, despite its seeming harmlessness, is a serious postoperative complication. The danger of developing an adhesive process is that it can lead to serious illness and cause unpleasant symptoms.

If adhesions are extensive, they are defined by the term "adhesive disease". Gynecologists say that it is necessary to differentiate the physiological and pathological adhesive process.

With hysterectomy, accompanied by amputation of the uterine body, scars from the connective tissue always appear. Such scars are physiological adhesions. However, if fibrous bands continue to grow and disrupt the functioning of neighboring organs, this pathology is called adhesive disease.

Fibrous strands are distinguished by a light shade and strength. In their structure, such adhesions resemble fibrous formations that connect organs.

The etiology and pathogenesis of adhesive disease are not well understood. Usually, the appearance of adhesions is characteristic of large-scale operations involving the amputation of several organs.

There can be several reasons for education. The formation of adhesions can be associated with the following factors:

• the duration of the operation;
• volume of intervention and blood loss;
• the presence of surgical and postoperative bleeding, which contributes to the appearance of adhesive disease;
• accession of infection in the period after surgery;
• genetic predisposition, manifested in the absence of an enzyme that dissolves the imposition of fibrin;
• asthenic physique.

The actions of the gynecologist during the operation are essential in the formation of adhesions. It is important whether the incision was made correctly and the postoperative suture was applied.

In gynecological practice, it is sometimes found that surgeons leave foreign objects in the peritoneal region during surgery(gauze pads, tampons). This may contribute to the development of symptoms of adhesive disease after amputation of the uterus.

Symptoms upon occurrence

Adhesions after hysterectomy surgery are known to have symptoms. However, these symptoms of adhesive disease after hysterectomy are not always pronounced. Despite the fact that the severity of symptoms is individual, suspect adhesions after surgery to remove the uterus by the following symptoms.

• Pain. A woman notices pains of a aching and pulling nature, which are stopped by taking painkillers. It is noteworthy that pain sensations can be both constant and periodic, and also reach considerable intensity.
• Disorders regarding urination and defecation. With adhesions, disorders of the excretory function are noted.
• Symptoms of disorders of the gastrointestinal tract. Quite often, adhesions after removal of the uterine body are manifested by flatulence, excessive intestinal motility.
• Rise in body temperature. Adhesions after removal of the uterus can cause both high and subfebrile temperature.
• Sore postoperative scar. An important symptom indicating the presence of adhesive pathology is pain in the process of probing the scar, as well as its swelling, redness.

Symptoms of adhesions are also pain during sexual intercourse. In some cases, there may be bloody discharge from the genital tract. Despite the presence of symptoms, an examination is necessary to confirm the diagnosis.

Diagnostic methods for detection

Diagnosis of adhesive disease after amputation of the uterine body is difficult. This is due to the fact that in most cases, it is possible to make an accurate diagnosis only in the process of laparoscopy or abdominal surgery.

It is possible to suspect the presence of adhesions after a hysterectomy after analyzing the patient's symptoms and history. It is possible to confirm adhesive pathology using basic diagnostic methods.

• Laboratory research. This is an additional method of examination, which involves a blood test, it helps to identify inflammation, assess the activity of fibrinolysis.
• Ultrasound of the abdominal cavity and small pelvis. This method of examination allows us to assume, and in some situations, to identify the presence of adhesions after hysterectomy by determining the incorrect position of the organs that are “pulled up” by adhesions.
• X-ray of the intestine. The study is carried out with the help of a contrast agent. This method is auxiliary, as it helps to assess both intestinal patency and narrowing of the lumen.
• Laparoscopy. This method is optimal for the diagnosis and treatment of adhesions after surgery to remove the uterus. The operating process involves the dissection and removal of adhesive formations.

Diagnosis of adhesions after amputation of the uterus is individual and depends on the symptoms and history.

Surgical tactics in the treatment

Adhesive disease is treated mainly with surgical techniques. This is due to the fact that conservative methods are ineffective and are used for prevention purposes, for example, in the postoperative period. Drug treatment is also used to eliminate unpleasant symptoms.

To eliminate adhesions after removal of the uterus, doctors use two types of operations:

1. laparoscopy;
2. laparotomy.

Laparoscopic surgery involves making several small incisions in the abdominal wall. These punctures are necessary for the use of special equipment in the operating period.

Laparoscopy has several advantages:

• dissection of adhesions is performed under the direct control of the optical system;
• tissue trauma is minimal;
• cutting adhesions with special instruments, followed by hemostasis;
• the absence of symptoms such as severe pain and postoperative complications;
• the recovery phase takes several days;
• rapid disappearance of symptoms of adhesions;
• the possibility of motor activity the next day after the operation.

Gynecologists note that laparotomy in the treatment of adhesions that have arisen after amputation of the uterine body is rarely used. Laparotomy is mainly used in the following situations.

• Inability to perform laparoscopic surgery.
• Symptoms of extensive adhesive disease in the peritoneum.

Operational stages in laparotomy involve the use of lower median access. Then the surgeons expand its top to fifteen to twenty centimeters. This tactic is necessary for a thorough examination of all organs and removal of adhesions.

Laparotomy is considered a traumatic operation. This is due to the fact that such an operation has a significant risk of operative and postoperative complications. Often, after laparotomy surgery, relapses occur, and the recovery period lasts about a month.

Gynecologists advise in the postoperative period to follow the recommendations of the attending doctor, to prevent the occurrence of adhesions. If you have reproductive plans, it is advisable to start planning pregnancy after the end of the recovery period.

Prevention education

The risk of surgical and postoperative complications largely depends on the actions of the surgeon. In this connection, the choice of a doctor should be approached responsibly. The postoperative recovery period also depends on the course of the hysterectomy.

As a material for suturing the incision, it is necessary to use only absorbable thread. Hysterectomy is considered a rather extensive and serious operation, and the threads are a foreign object - an antigen for the body. Over time, the threads become overgrown with connective tissue. Subsequently, the formation of adhesions begins. Accordingly, the nature of adhesions also depends on the correct execution of the seam.

In the postoperative period after amputation of the uterine body, drug therapy is mandatory. The patient was advised to take broad-spectrum antibiotics. These drugs are the prevention of infection and inflammation. It is also advisable to use anticoagulants.

To eliminate symptoms after surgery, as well as to prevent adhesions, physiotherapy is performed. In particular, electrophoresis destroys the formation of adhesions and reduces the severity of symptoms in the early postoperative stage.

After the removal of the uterus by hysterectomy, the patient undergoes regular examinations, including ultrasound of the small pelvis and gynecological examination.

Early motor activation of the patient after removal of the uterine body is essential. For example, in the process of walking, intestinal motility may improve, and the risk of adhesions will be reduced.

Surgical treatment implies adherence to the correct diet. A woman should avoid spicy, salty and fried foods, as well as alcohol and carbonated drinks. Improper diet impairs digestion, which contributes to the weakening of intestinal motility.

Operational tactics involves fractional nutrition. Eat preferably in small portions six to eight times a day. Such a diet will not contribute to intestinal overload, and the possibility of adhesion formation will be significantly reduced.

After discharge from the hospital, a woman must follow the doctor's instructions, in particular, take prescribed medications, and conduct physiotherapy. In some cases, you can use folk remedies to prevent adhesions after surgery to remove the uterus.

Adhesions after removal of the uterus are a common complication and occur in 90% of operated women. This is a dangerous consequence of surgical intervention, since as a result various functional disorders in the functioning of internal organs can occur, up to symptoms of intestinal obstruction.

What are spikes

Extensive adhesions of internal organs are also called adhesive disease by doctors. However, it is important to distinguish the physiological process of adhesion formation from the pathological one.

Removal of the uterus (hysterectomy) is always accompanied by the formation of connective tissue scars at the sites of scars and incisions. The resulting scars are physiological adhesions. The scarring of the wound gradually stops, due to which the normal functioning of the organs is restored, and the symptoms of inflammation disappear.

Important! The process of formation of adhesions (or scarring) after removal of the uterus is a normal physiological condition that has nothing to do with pathology. If the formation of connective tissue does not stop, and fibrous cords grow and grow into other internal organs, this is a pathology called adhesive disease. It has its own symptoms and requires serious medical intervention.

These pathological fibrous bands have a whitish hue. They look like fibrous formations that connect the internal organs. The strength of the strands is high, which is why it is necessary to resort to a second operation to remove them.

Reasons for the formation of adhesions after removal of the uterus

In the body, adhesions occur mainly only after extensive operations that require the removal of one or two organs at once. The reasons for their occurrence are diverse and depend on a number of factors:

• How long was the operation.
• The amount of surgery.
• The volume of blood loss.
• Internal bleeding in the postoperative period. In this case, there is an active resorption of blood accumulated in the abdominal cavity, and this predisposes to the occurrence of adhesions.
• Infection of wounds in the postoperative period.
• genetic predisposition. This is due to the fact that a special enzyme is not formed in a genetically predisposed organism that can dissolve fibrin overlays, which ultimately leads to symptoms of adhesive disease.
• People of asthenic physique.
• In addition, the occurrence of adhesions depends on the actions of the surgeon himself. What is important here is how correctly the incision was made, what suture materials were used, how professionally the suture itself was applied.
• There are cases when surgeons left foreign objects in the abdominal cavity. It also predisposes to the development of adhesions after hysterectomy and the onset of symptoms of adhesive disease.

Symptoms of adhesions after surgery

You can suspect adhesive disease in a woman who has recently had a uterus removed by the following symptoms:

• Aching or pulling pains in the lower abdomen, forcing to take an antalgic (forced) position. Pain can be permanent or intermittent, reaching a high intensity.
• Delay and other disorders of urination and defecation, up to the absence of urine and feces.
• Symptoms of dyspeptic disorders: pain throughout the abdomen, flatulence and gas formation, "sheep feces", a feeling of increased intestinal motility and others.
• Subfebrile or febrile body temperature (increase to 38-40 C).
• Feeling of severe pain when probing the postoperative scar, its redness and swelling.
• Pain during intercourse. Discharge from the vagina is bloody.
• If several weeks have passed since the removal of the uterus, then when these symptoms appear, you should immediately contact your doctor (gynecologist).

Important! Symptoms of adhesive disease are nonspecific. This means that if a woman makes such complaints, then no qualified doctor can say with full confidence that she has formed adhesions in the small pelvis. To confirm the diagnosis, instrumental and laboratory methods of examination are necessary.

Diagnosis of adhesive process in the postoperative period

A preliminary diagnosis is made after a thorough history taking, patient complaints and symptoms of the disease. To confirm the presence of adhesions, the doctor prescribes an additional examination:

• General blood analysis. Needed to check if you have inflammation in the body. Also evaluate the activity of the fibrinolytic system of the blood.
• Ultrasound of the abdominal cavity and the pelvic cavity. The visual method of examination helps with a 100% guarantee to say whether there is an adhesive process in the small pelvis after the operation of removing the uterus.
• X-ray examination of the intestines with the help of contrast (coloring) substances. An auxiliary method that allows you to judge the patency of the intestine and the degree of narrowing of its lumen.
• Laparoscopic diagnostics is also used, during which individual adhesive formations are dissected and removed, and the issue of repeated surgical intervention is also resolved.

Surgical treatment of adhesions

Mostly adhesive disease is treated surgically. This is due to the fact that conservative treatment is not effective, it is used only as a prophylaxis in the postoperative period and to relieve the symptoms of the disease.

There are 2 types of operation:

1. Laparoscopic surgery. It is carried out using special fiber optic equipment. At the same time, 2-3 small incisions are made on the skin of the anterior abdominal wall, and then the abdominal wall is pierced in these places. These incisions provide access to the abdominal cavity. The advantage of this operation is that the dissection of adhesions is carried out under the control of the optical system, with minimal trauma to internal organs. With the help of special laparoscopic instruments, fibrous cords are cut, followed by hemostasis. Pain and complications after such surgery are extremely rare. The recovery period takes several days, the symptoms of the adhesive process disappear almost immediately, physical activity is possible the very next day after the operation.
2. Laparotomy. Shown in two situations:
   • There is no possibility of laparoscopic surgery.
   • The presence of symptoms of an extensive adhesive process in the abdominal cavity.

   In this case, the lower middle access is used first, and then it is expanded upwards to 15-20 cm. This is done in order to carefully examine all organs and remove overgrown adhesions. Such an operation is highly traumatic, has a risk of postoperative complications or recurrence of the disease. The recovery period takes about two weeks.

After the operation of dissection of adhesions, it is necessary to constantly visit the attending physician in order to observe the processes occurring in the small pelvis

Important! No doctor can give a full guarantee that adhesive disease will not return to you again. Removal of adhesions is the same operation as removal of the uterus, which means that fibrous bands between organs can form again. To prevent this from happening, follow the doctor's recommendations in the postoperative period and prevent the recurrence of the disease.

Prevention of adhesion formation

If you are scheduled for surgery to remove the uterus, carefully approach the choice of a surgeon. The course of the postoperative period largely depends on it.

What will the doctor do

Only absorbable surgical suture material is used to suture the wound. This is necessary as a hysterectomy is an extensive and highly traumatic operation. Threads are a foreign body that will become overgrown with connective tissue and subsequently form adhesions.

Professionally sutures when the edges of the wound are in contact throughout with each other.

Drug prevention of adhesive disease in the postoperative period. The doctor prescribes broad-spectrum antibiotics (to prevent infection, suppress inflammation), anticoagulants.

Early appointment of physiotherapy with electrophoresis of enzymes that destroy fibrin (lidase, hyaluronidase and others). They destroy dense adhesive formations, which contributes to the rapid extinction of the symptoms of the disease.

Dynamic observation after surgery, careful monitoring of the state of the pelvic organs using ultrasound.

What should you do

Early physical activity after hysterectomy is important for the prevention of adhesions. The fact is that while walking improves intestinal motility, which prevents the development of adhesions.

The second point is diet. Eliminate salty, spicy, fried, alcohol, carbonated drinks. They disrupt digestion, and intestinal motility weakens. It is necessary to eat up to 6-8 times a day in fractional small portions. This will not overload the intestines, which means it will not be constricted by fibrous overlays.

With regards to folk methods of treatment, they can be used as an addition to drug therapy and only after consulting the attending physician. For the prevention and treatment of adhesions in folk medicine, infusions and decoctions of plantain, dill, flax seeds, St. John's wort, aloe leaves are used.

Summing up

Adhesive disease disrupts the physiological functioning of all organs of the abdominal cavity. It is a consequence of highly traumatic operations. Advanced forms of adhesive disease can only be treated by surgery, but this also harms the body. To prevent this from happening, it is necessary to follow the recommendations of the attending physician in the postoperative period and to prevent the recurrence of the disease. When the first symptoms appear, indicating the presence of adhesions in the body, you should immediately consult a doctor for consultation and subsequent diagnosis.

Video: When to be afraid of adhesions? The main symptoms of impending problems

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 significant 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 dysfunction of the organs.

If 2 adjacent leaves 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 one 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 methods 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).

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.

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. Most 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.