Can Adhesions Be Removed Laparoscopically? Procedure

What are adhesions?

The process of removing adhesions through a laparoscope is called laparoscopic adhesiolysis.

Adhesions are bands of scar tissue that form between the organs. Adhesions can result from disease (such as endometriosis), infection (such as pelvic inflammatory disease), and injury (following abdominal surgery) or may have no known cause (idiopathic adhesions). More than 95% of patients who undergo abdominal surgery develop adhesions, although most adhesions are asymptomatic.

What causes adhesions?

Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, trauma, or radiation. Repaired cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself or another organ, scar tissue may form an adhesion connecting the two surfaces.

What does adhesiolysis mean?

Adhesiolysis is the first step of adhesion surgery, the process of separating structures that have been fused by adhesions. To carefully remove all adhesions and scarring without causing damage to the other structures, advanced laparoscopic surgical skills and extensive knowledge of anatomy are required. 

Once all adhesions have been carefully separated, the patient will typically be left with multiple areas of the raw tissue. If these areas are left as they are, adjacent structures may stick to these raw areas resulting in new adhesions. This process typically occurs during the first hours and days following surgery and these newly formed adhesions may then go on to thicken and tighten during the following months. Some people have a greater tendency to form scar tissue and adhesions than others.

Can adhesions be removed laparoscopically?

The process of removing adhesions through a laparoscope is called laparoscopic adhesiolysis. Doctors typically diagnose adhesions during a surgical procedure with laparoscopy. 

• If they find adhesions, doctors usually release them during the same surgery using tools threaded through the laparoscopic tube and guided by video images from the scope’s lighted camera. 
• This procedure is usually done under general anesthesia. 
• The surgeon makes a small incision in the area of adhesion and uses a laparoscope to locate the adhesion. 
• The laparoscope will project images onto a screen, and the surgeon cuts out the adhesions. 
• The wounds are sutured with skin absorbable stitches. 
• Laparoscopic adhesiolysis usually takes less than three hours. 

Advantages of laparoscopic adhesiolysis are: 

• Less postoperative pain
• Decreased incidence of hernia
• Reduced recovery time
• Shorter hospital stay

What are the common complications of laparoscopic adhesiolysis?

The surgery is minimally invasive, but there are still possible complications, which include:

• Injury to organs
• Worsening of adhesions
• Hernia (organs pushing out through muscle or tissue walls)
• Infections
• Bleeding

What is pelvic inflammatory disease (PID)?
See Answer

How long does it take to recover from laparoscopic adhesiolysis?

The patient may have discomfort around the operated site for about two weeks. They can return to regular activities in two to four weeks. It may also take several weeks for bowel movements to become regular again.

To improve recovery from abdominal adhesiolysis surgery, take the following steps:

• Get plenty of rest
• Avoid intense physical activity
• Eat a healthy diet
• Wash the surgical wound daily with soapy water
• In case of fever, swelling or redness at the operated site immediate medical attention is needed