Scars that strangle (3) – Assessing some answers to adhesions

How we can prevent abdominal adhesions?

How do we deal with adhesions that cause us real grief?

Many of us have adhesions, rogue fibrous or scar tissue which connects and can affect our internal abdominal organs.   Two previous blogs with a similar title have looked at this subject from various angles.

A laparoscopic image of adhesions between the right diaphragm and liver

I had an open operation for pyloric stenosis when two weeks old and I can massage to detect the adhesions from this, but I am grateful that they have not troubled me yet – and therefore probably won’t.  The difficulties this surgery has caused me are in a different area.

If you’ve had abdominal surgery, there is a big chance that adhesions have developed, starting within days of the operation and over the years sometimes causing discomfort and pain, and very sometimes serious obstructions to the working of our internals – which sometimes demands emergency intervention.

The likelihood of troublesome adhesions developing can be reduced by avoiding surgery if possible, keeping incisions small, and minimising the handling of abdominal organs and especially not bringing them outside the body.  Surgeons who use latex or starch-free gloves reduce the likelihood of adhesions forming.  Keeping the abdominal organs moist and not exposing them to drying gases is also desirable.  Much can be done to minimise the adhesions problem.

Whilst it is advisable that surgery to remove adhesions be regarded as a last resort, any surgery should if possible be laparoscopic, but (apparently from the reports I have seen) using gases other than CO2.  And need it be said, all this is especially true of surgery on babies!  Infants are so much more vulnerable to big surgical hands and everything else that comes with them.

What happens if you cannot live with your adhesions?

The statistics for the removal of adhesions by open surgery are terrible: in 90% of cases the growths and pain will return, and often more quickly and extensively. Laparoscopic treatment is more effective, three studies reporting a 75% success rate.  No wonder some people feel they get the “runaround” when they go to their local doctor with what they fear are adhesions.

It is also clear that there is a large element of mind as well as matter in this area: in one study 50% of patients who had a laparoscopic procedure for their adhesions reported a marked reduction in pain – although the surgery had not actually removed any adhesions (adhesiolysis).

Finding the cause of abdominal pain and avoiding unnecessary and counter-productive surgery are often very difficult. If you have had past abdominal surgery and any abdominal pain develops, decide first whether you can live with it, considering perhaps diet changes, counselling and other support.

If necessary, find a doctor who will take your history and trouble seriously.  It is sad but true that some doctors are not skilled in this area of medicine and personal care.   Face it, not every trades worker is worth their price, and doctors too have many different skills.

When there is abdominal pain but no actual obstruction is present, no diagnostic tests are available, so a careful investigation is necessary, using endoscopy, laparoscopy and possibly radiology.

Some practical considerations are –

  1. Avoid abdominal surgery if at all possible.  Most surgeons will urge parents of infants with an abdominal problem to consent to surgery, which is quick (and lucrative).  However, conditions like infant pyloric stenosis in most cases can be managed with lower risks and costs (but taking longer) by medical drug treatment (… and yes, the statistics show this).
  2. Find a surgeon who is known for skilful and successful work. Small incisions, minimal organ handling, and careful wound repair are essential to reduce the risk of later problems.
  3. Or ask your doctor refer you to a skilled surgeon – one he would ask to work on his or her body!
  4. Assess your surgeon’s ability to talk about the professional standards for surgery that keeps the area worked on free of excessive damage and contamination.
  5. Ask your surgeon to give you a drug that inhibits adhesions.
  6. Ensure that your surgeon uses synthetic material to inhibit adhesion formation inside the body.

For more detailed information, check out websites such as –
http://www.ehow.com/how_4451464_prevent-abdominal-adhesions.html
http://www.laparoscopytoday.com/2004/01/when_to_operate.html
http://www.laparoscopyhospital.com/laparoscopy_and_postoperative_adhesion.htm

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