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What are the causes of postoperative adhesions? When we need to undergo surgery, we rarely ask about complications after surgery. We are more interested in the surgeon's experience and the scope of the operation. Meanwhile, each surgical procedure results in the formation of adhesions, a complication that is neglected by both patients and doctors.
Postoperative adhesionsoccur in up to 93% of operated patients, including 60-90% women who have undergone surgeries and gynecological procedures. Experts believe that adhesions are the most common complication of open or laparoscopic abdominal and pelvic surgery today.
Postoperative adhesions are otherwise abnormal scars
Adhesions are the result of abnormal, albeit natural, connection of tissues between which fibrous scarring occurs. During each surgical procedure, regardless of its extent, there is a violation of the continuity of tissues, which are technically called a surgical trauma. A scar is formed in the wound healing process and this is considered normal. But when the tissues heal in the wrong way, they form adhesions. The first ones are created 3 hours after the end of the operation.
Complications of adhesion disease
Although they do not always cause specific ailments, the annoying symptoms of adhesions are usually dull pains in the lower abdomen and middle of the abdomen, painful flatulence, constipation, and a feeling of strong distension. The most serious complication of adhesion disease, as this is how specialists describe the existence of postoperative adhesions, is intestinal obstruction - especially of the small intestine.
In most such cases, a new operation is necessary and the so-called release of adhesions. Unfortunately, it is at a high (6-8%) risk of death or a significant narrowing of the intestinal lumen. In women, painful periods and pain during sexual intercourse (15-20% of women) may be an unpleasant symptom of the existence of adhesions. The consequences are fertility disorders. This is because the streaky adhesions that exist between the ovaries and fallopian tubes change the anatomical structure of the pelvic organs.
This, in turn, may disturb the course of ovulation, the capture of the egg and its movement through the fallopian tubes. It is then said aboutmechanical infertility.
Operations causing the formation of adhesions
Smaller or larger adhesions are formed after each surgical intervention, even after a simple blood sampling or biopsy. But adhesions that affect our well-being and he alth more often form after open surgical procedures in the abdominal cavity and after laparotomy, and less often after laparoscopic procedures - here there is less tissue damage, because the precision of the operation is greater.
The following operations are particularly conducive to the formation of large adhesions:removal of ovarian cysts ,ectopic pregnancy, uterine fibroids, endometriosis(this the operation gives the highest percentage of adhesions), but alsocesarean sectionandhysteroscopic procedures , which promote adhesions in the uterine cavity.
The experience of countries where the problem of postoperative adhesions is taken seriously shows that symptoms that are troublesome for the patient may appear even 10 years after the procedure has been performed.
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