Drugs for adhesions after surgery. How to prevent adhesion formation after surgery. Possible causes, dangers, types of diagnosis and treatment of postoperative adhesions

2012-04-26 05:55:29

Ludmila asks:

After the removal of the uterus and appendages on the right, 3 years have passed, during intercourse, severe pain in the abdomen and gives in all directions and into the anus, when ultrasound was done a year ago - adhesions, how can I alleviate my condition and are adhesions curable?

Responsible Kravchenko Elena Anatolievna:

Good afternoon, Lyudmila. Adhesive disease is treated surgically. To alleviate your condition, visit a gynecologist, he will examine you and prescribe a treatment and a consultation with a surgeon.

2014-07-10 12:35:49

Carey asks:

I have adhesions after the operation to remove the ovarian cyst, and there was also inflammation of the appendages, The gynecologist prescribed vitamins B1, B6 and aloe intramuscularly, the inflammation went away, but colposcopy showed erosion of the cervix, Yesterday I was cauterized with erosion of the cervix, I also continue to take injections intramuscularly Vitamins B1, B6 and aloe, tk. the course is not over yet, is it harmful after cauterization of erosion?

2013-11-08 19:12:13

Margaret asks:

Hello November 5 this year was a milk surgery in gynecology. Dissection of adhesions after 2 cesarean; How to behave after the operation I have 2 children 3 and 5 years old
I am alone with them. what is needed and how long does the recovery process take, what is impossible?

Responsible Serpeninova Irina Viktorovna:

The recovery period, which requires restriction of physical activity, usually lasts six months, but in each case, recommendations are given by the operating doctor.

2012-01-04 14:09:56

Ludmila asks:

Hello. In August 2011, I had an operation to remove the uterus (myoma). In December, signs of adhesions-pain began to appear, there was even an attack. I want to ask if I can take the drug Longidase in suppositories rectally. I myself am a pharmacist, I know about this drug, I want to consult with you. an assumption about them. After the operation, a histology of the tissues was done - there was a leomyoma of the uterus, leukoplasia of the cervix with stromal fibrosis. Thank you in advance for your answer.

Responsible Serpeninova Irina Viktorovna:

Longidaza is a powder for preparing a solution for intramuscular or s / c injections in ampoules or vials. It is not produced in suppositories and there is no evidence whether its properties will be preserved when preparing suppositories from it on its own. Use it in the way recommended by the manufacturer.

2011-03-06 18:36:34

Ramsia asks:

Hello dear doctors!
07/01/2009 at the age of 47, I underwent surgery for cervical dysplasia of the 3rd degree. (The focus was in the neck measuring 05. * 1 cm) - cervical extrusion with appendages. There was no menopause and the ovaries were healthy, but the gynecologist-oncologist advised me to urgently remove the ovaries before the operation, as well. taking into account their experience and my pathology, I can get to them again on the operating table with such a pathology or even worse. They left me no other options and I agreed.
After the operation, she felt more or less satisfactory.
But after 8 months there was pain in the lower abdomen, a feeling of heaviness. The pain radiates to the sacrum, rectum. I stopped feeling the urge to defecate. I feel some kind of unpleasant sensation, and with a digital examination I feel that the rectal ampulla is full of feces and I feel the bulging of the vaginal stump into the rectum. Weakness, fatigue. These pains have been tormenting me for a year now. She became nervous and irritable. I’m already thinking about suicide (I wish I could take sleeping pills and fall asleep, forget about this pain). I have been taking Angelique for 7 months, because. there were hot flashes and increased glucose, cholesterol and bladder problems. It got a little better.
On CT scan of the small pelvis - Condition after extirpation of the uterus with appendages. The stump of the vagina with clear uneven contours, the surrounding tissue with fibrous changes and "small" calcifications. The bladder is significantly filled, of the usual form with clear, even contours, the contents are homogeneous.
Ultrasound of the pelvic organs: In the small pelvis, there is an adhesive process, no visible formations have been identified. The bladder has clear, even contours, the walls are compacted, without visible additional formations.
Volume of initial urine:-350 ml.
The volume of residual urine is 55 ml.
Irriography - With the retrograde introduction of a liquid barium suspension, all sections of the large intestine were performed up to the dome of the blind. The localization of the loops of the sigma and the descending colon is disturbed. The descending colon is displaced medially, binds the knee bend, the sigma forms multiple loopy bends and kinks against the background of its lengthening, the displacement of the loops is sharply limited and painful. In the descending colon, in the sigma, the haustration is smoothed, uneven, the mucosal folds are moderately thickened. Symmetrical haustration is preserved throughout the rest of the colon. No organic constrictions or filling defects were found.
conclusion: R signs of violation of the anatomical localization of the distal colon as an indirect sign of adhesive disease, signs of chronic colitis.
EGDS-Esophagus is freely passable. The mucosa is pink. Gastric mucosa, pink, edematous. Pyloric sphincter concentric. Bulb 12 of the duodenum is not deformed, the mucosa is pink, it looks like “mannoly cereals!” The onion part is pink.
Conclusion - superficial gastritis. Moderate inflammation. Indirect signs of pancreatitis.
Colonoscopy - perianal area is clean. Colonoscopy was performed up to the splenic angle of the colon. The mucosa is pink throughout, the vascular pattern is not changed. The peristalsis is uniform. The conclusion is that there were no signs of inflammation.
A few days ago, I went for a consultation with a surgeon and a gynecologist about adhesive disease. The gynecologist prescribed electrophoresis on the lower abdomen with lidase (1.5 years have passed since the operation), will lidase help now? I heard about longidase. What is it? Does it help?
The surgeon looked at my examination results and sent me to an oncologist: let them figure out what kind of "small" calcifications on the peritoneum! If the adhesive process
then we will wait for the OKN. Then, according to emergency indications, we will operate.
IN HOW! So you have to wait for OKN or peritonitis or intestinal necrosis! And if the ambulance does not arrive on time or will bring to a drunken surgeon for the holidays! What then! Die!
2 days ago I went to another surgeon, because. no strength to endure the pain. The female surgeon looked at all the examinations and my stomach and diagnosed it as an adhesive disease of the abdominal cavity. Dolichosigma. Colonoptosis. Coccygodenia.
She prescribed Movalis, candles. Milgama No. 10 Magnetotherapy on the cross. Electrophoresis with novocaine No. 10.
She advised me to go for a consultation with a proctologist - maybe she says prolapse of the small intestine?
I'm tired of doctors, drugs and pain. I don't want to live! But it seems like she’s not old yet, and I need to work a lot, I have a loan in a bank. But I can’t work.

Tell or Say please, it is possible to remove commissures by a laparoscope. I heard it's done. We do not have it in Astrakhan, and our surgeons are against this method of removing adhesions. They say how you inflate your stomach with carbon gas, when you have it all in adhesions, Even the normal anatomical position of the intestine is disturbed! Yes, and you can die during this operation. In general, they consoled me.
And further. Please tell me what research method and which doctor can diagnose prolapse of the small intestine?
If in my situation it is possible to dissect the adhesions with a laparoscope, then where is it done well (so as not to earn even more problems and die) After the hysterectomy with appendages, for cervical dysplasia 3 tbsp. In the histological response after the operation, the endometrium is in the proliferation phase. FBG, fibromyoma. In the neck of the gland of the endocervix. In the area of ​​​​the external pharynx, a squamous epithelium with parakeratosis, hyperkeratosis. In the ovaries, theca tissue, white bodies. Given the results of this histological picture, did I have endometriosis? if so, can there be pain in the abdomen due to this or is it adhesions? If you have endometriosis, how can you treat it?
Help me please. Thank you.

Responsible Tovstolytkina Natalia Petrovna:

Hello Ramsia. Let's start with the last question. The data of your histological conclusion do not give any reason to suspect you have endometriosis. Regarding the adhesive process, it is very doubtful that it began 8 months after the operation. Rather, it could have been earlier, but it is necessary to look for another cause of the pain that has appeared. You need to start with a consultation with a neurologist, perhaps an MRI scan to rule out diseases of the spine that can give similar pain. Hormone replacement therapy is also mandatory - then thoughts of suicide will pass by themselves. With regard to enzyme preparations, it is very doubtful their effect in a year or two after the operation. After another operation to cut the adhesions, you may develop new ones, because. This is how your body reacts to surgical interventions. And do not forget about a healthy lifestyle - a diet that does not constipate, exercise therapy, swimming pool, etc. 80% of health is you yourself, without doctors and medicines. Good luck.

2008-10-19 01:43:38

Anna asks:

Hello! Please advise how should I proceed. In 2005, I had a cyst removed from my left ovary (laparoscopy). She was then treated with danazol for 5 months. X-ray tubes showed complete obstruction of the left and partial right. Now they put (ultrasound) adenomyosis of the uterus, the initial stage. Symptoms of endometriosis appeared 4 months ago (discharge 2 days before menstruation and heavy clots on day 2). I was scheduled for an operation to dissect adhesions and remove foci of endometriosis and HSG. Should I undergo hormonal treatment before surgery.

Responsible Bystrov Leonid Alexandrovich:

Hello Anna! Usually, endometriosis undergoes hormone therapy after laparoscopy, because. laparoscopy can also reveal other forms of endometriosis. If there is a laparoscopy, then the HSG is no longer needed.

2016-03-30 15:58:25

Christina asks:

Hello!
I am 34 years old, married for 4 years, I can not get pregnant, myoma or polyp on the leg inside the uterus. After MRI and ultrasound, the doctors did not determine.
I am going to have an operation to remove this disease and at the same time check the patency of the fallopian tubes.
The doctor said about postoperative adhesions, so he warned that he would use Intercoat gel.
What do you think: is it harmful to use this gel?
And after this surgical intervention, will I be able to carry a child after artificial insemination?

Thank you in advance,
Kristina

Responsible Palyga Igor Evgenievich:

Hello Christina! Are you planning a laparoscopy? Or a hysteroscopy? In any case, after these two interventions, postoperative adhesions are not formed. If the fallopian tubes turn out to be impassable, then not a single gel will help. If the gel is injected into the uterine cavity, it will not adversely affect the implantation of the embryo during IVF, as well as the carrying of the pregnancy.

2014-10-03 17:08:27

Natalia asks:

Tell me, please, is it possible to engage in masturbation and oral sex after laparoscopy of uterine fibroids (5 subserous nodes) and removal of adhesions. The mother was left. The operation was 24 days ago. The doctor said sexual rest for 2 months.

2013-08-07 11:41:27

Elena asks:

Hello, I am 35 years old, 5 pregnancies 1995 - abortion, 1997 abortion, 1999 - pregnancy, ended with the birth of a healthy child (rupture of the cervix during childbirth), 2010 - missed pregnancy (no one saw the fetus on ultrasound, ended in miscarriage, pregnancy diagnosed posthumously by hCG, 2013 - pregnancy after IUI, froze for a period of 6 weeks 4 days.
Over the past year I have experienced the following:
1. August 2012 - cyst rupture, resulting in an attack of appendicitis, abdominal surgery, 2 courses of antibiotics.
2. October 2012 - hospitalization in an ambulance, pain syndrome, endometrioma + terrible endometriosis + adhesive process was diagnosed, no surgery, a course of antibiotics. Appointed Visan, did not take it, decided to consult with other specialists.
3. It turns out that every 2 months (when the left ovary is working) a pain syndrome occurs, literally the whole body hurts, the temperature is up to 38.
December 2012 - planned laparoscopy to remove the endometrioma (3.7 cm), dissection of adhesions. Before operation again a pain syndrome. Terrible endometriosis was not confirmed by laparoscopy. No hormonal support after the operation was prescribed, they said to become pregnant.
4. May 2013 - IUI (in addition to all of the above, there is also a male factor. Before IUI, an endometrioid cyst of 3.5 cm was visible on ultrasound. Pregnancy occurred on the first attempt. After ultrasound at 6 weeks, the doctor canceled utrozhestan. Pregnancy froze for 6 weeks 4 days.
5. July 2013 - vacuum regulation, on the 4th day after it, pain syndrome.

What could be the most likely cause of the fading?
1. The presence of an endometrioid cyst.
2. Cancel Utrozhestan
3. Genetic abnormalities (analysis for karyotypes is not yet ready)
4. Long flight by plane (at 4 and 6 weeks)

And the most important question: is it possible to attempt IUI again and when, and how it can end. 2 missed pregnancies - a trend, the 3rd time is scary.

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;
• , or abdominal-pelvic pain syndrome;
• menstrual irregularities and (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 disturbances of metabolic processes in them, as well as inappropriate temperature conditions of the gas when using CO 2 -pneumoperitoneum for conducting;
• 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 the procedure, and therefore the prevention of adhesions after removal of the uterus is of the greatest importance, compared with other gynecological operations.

In obstetrics, delivery through delivery 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 fallopian tubes and other diagnostic laparoscopic procedures. 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.

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.

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.

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.

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.

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 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.

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 will be to repeat the operation, but to remove 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.

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 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.

Recipe 3. For cooking, you need aloe, but one that is 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.

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.

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 tint. 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

What happens to our body during operations? First, the tissues are cut, then connected, and they are forced to grow together again. It is believed that laparoscopic surgery, which is performed through several small incisions (“punctures”), is much less traumatic, since the surface of the surgical field is significantly smaller than with a conventional band “open” operation.

During laparoscopy, on a thin membrane covering the inner surface of the abdominal wall, damage is formed at the points of passage of instruments, incisions or clips. After the instrument is removed, this section of the damaged membrane (called the serous membrane) heals on its own.

How do adhesions and scars form?

However, our tissues have one natural property that cannot be canceled - they seek to protect our body. And sometimes the development of so-called protective factors after damage occurs intensely - with a margin.

What is the treatment of adhesions after surgery?

In practice, it looks like this: in places of damage to the serous membrane, collagen and elastic fibers and connective tissue cells are intensively produced. If at this time some internal organ (for example, a loop of the intestine) touches the site of the damaged serosa, it is involuntarily involved in this process. A cord is formed from the connective tissue, which leads from the wall of the internal organs to the inner surface of the abdominal wall. This is called soldering.

Adhesions can also connect internal organs to each other. Each of them also covers the serous membrane. During the operation, its micro-tears are not excluded. And these places of microtrauma can also subsequently become a source of formation of adhesions between this organ and the organs adjacent to it.

Also, at the site of contact and healing of tissues after their dissection or rupture, a scar may form, in which ordinary tissue is replaced by a more rigid and inelastic connective tissue. Scars can be on the skin, and may be on the internal organs.

Why are sleepers bad?

Nature took care that in our harmonious body the organs were completed and laid out clearly and correctly, as in Tetris. They occupy the entire interior space and touch each other with suitable sides, like a carefully fitted puzzle. If we consider all the organs separately from the body, one can be amazed at how much space they occupy and how they fit inside us! Precisely because postoperative scars and adhesions violate this original harmony, they affect our body.

What is the negative effect of adhesions. They are:

• disrupt the mobility of the organ, which affects its function. Moreover, both external mobility, which depends on the movements of the diaphragm, and internal mobility, which is active and does not depend on the movement of the diaphragm, suffer;
• disrupt blood circulation in the affected organ;
• violate the innervation of the body;
• contribute to the occurrence of pain and spasms in the organ.

Sometimes the adhesion is so powerful that it can disrupt the anatomically correct position of the organ. All of these causes lead to other disorders in the body. Moreover, which at first glance are not connected with the affected area. Adhesions and scars that have arisen after abdominal surgery can “radiate” with pain in various parts of the spine, joints, lead to a change in posture and a violation of the position of the body in space, etc.

How are adhesions treated?

According to the timing of the formation of adhesions, there are:

• 7-14 days after the operation - the phase of young adhesions, when adhesions are still very loose and easily torn;
• 14-30 days after the operation - the phase of mature adhesions, when the adhesions are compacted and become strong.

Starting from the 30th day after the operation and further, for several years, there is a process of restructuring and the formation of scars and adhesions. The process is individual, much depends on the properties of the organism itself, its anatomical structure, the functioning of internal organs.

The doctor may suspect the presence of an adhesive process in the abdominal cavity according to clinical data, the collection of anamnesis and the results of such studies as ultrasound, CT, colonoscopy. The adhesive process in the abdominal cavity and the pelvic cavity can be treated medically or surgically. During the operation, the adhesions are separated, but this method should be resorted to only in extreme cases, if the cords are so thick and coarse that they greatly impair the function of the organ, and a more loyal and sparing treatment does not help.

How osteopathy affects adhesions

The osteopathic doctor is able to feel with his hands where the adhesions are located and where they lead, where they are attached and what they pinch. He is also able to loosen their tension in a few sessions, can restore, balance and balance damaged organs, and therefore restore their function to the fullest extent possible.

It is also in the power of the osteopathic doctor to interrupt the chains of damage and pain in the parts of the body that seem to be unrelated to the operated area. After all, our body is a holistic system where everything is interconnected. The osteopath directly affects the adhesion, without violating the integrity of body tissues, and therefore without an additional factor stimulating the formation of connective tissue. By restoring and harmonizing the function of the suffering organ, the body releases energy to launch a complete recovery in possible individual conditions for the whole organism.

Any surgical intervention, no matter how minimally sparing it may be, leaves behind a lot of negative changes, injuries and stress that the body has to deal with alone. What the body will undertake for its treatment, what it will sacrifice, how it will limit itself is always individual. But within the framework of self-preservation, this is always expressed in the loss of function to one degree or another, and hence the subsequent suffering of the whole organism with loss of compensation and the expenditure of much greater forces for normal functioning throughout life.

Therefore, if in your life you have had surgical interventions on the abdominal organs, consult an osteopath. It does not matter whether the operation was conventional or performed using a gentle laparoscopic method. Any discomfort has a reason, which means there is an opportunity to solve it.

An osteopath can use pulse diagnostics to determine the significance of adhesions or scars on the body. This means that if the properties of your pulse change when you press on the postoperative scar, then this zone is important and significant for the whole body, and you need to work with this adhesion or scar.

Adhesions and scars have the following significance and prevalence of influence:

• local (the effect is limited to the area where the scar or adhesion is located);
• regional (the influence extends to the entire chest or abdominal region where the spike is located);
• global (affects the entire organism, up to a violation of its position in space).

How long does osteopathic treatment last?

If the patient has undergone surgery, then tactically the osteopath will act as follows. 10 days after the operation, when the sutures are removed, the doctor will work with the scar itself in layers, work with the tissues directly around the scar itself and restore that independent mobility of the organ, which does not depend on the movement of the diaphragm. This period of work is within 10 days to 3 months after the operation.

If the duration after the operation is 3 or more months, then the doctor will pay attention to all surrounding organs and tissues in the operation area, influence the mobility of all internal organs in general and directly to the localization sites of the adhesions themselves.

The information was prepared by the leading specialist of the clinic of osteopathy and family medicine Osteo Poly Clinic, osteopathic doctor, chiropractor, endoscopist surgeon.