A.) What are adhesions? Adhesions are fibrous bands connecting structures that are normally separate. Adhesions develop as normal tissue responds to some form of injury.
B.) Why are adhesions a problem? Adhesions can lead to a variety of complications which include pelvic pain, infertility, bowel obstruction and prolonged operative and recovery times.
C.) Why do adhesions form? Some of the causes of adhesion formation are:
** Trauma is frequently a major contributor to the formation of adhesions. It has been shown that adhesions which form or develop after surgery are a result of the body's normal healing process.
** During a surgical procedure blood flow often must be disrupted by the cutting, coagulation or tying of sutures. This disruption can result in ischemia (lack of blood supply). This can also lead to inflammation and cause adhesion formation.
** Foreign Bodies can also cause an inflammatory reaction in the body. A foreign body can be suture material, lint from sponges, or talc from gloves. Local cells respond to the foreign body causing cells to release factors that incite an inflammatory reaction and adhesions may result.
** Hemorrhage or bleeding brings blood products into the operating field. The raw surfaces from the operation plus the blood from tissues can enhance the formation of adhesions.
** Infection from a variety of sources, endometriosis, or pelvic inflammatory disease can cause inflammation which results in adhesion formation.
D.) What can be done? Surgeons have developed microsurgical techniques that minimize trauma, ischemia, foreign bodies, hemorrage, raw surfaces and infection to reduce adhesion formation.
1.) Microsurgical Techniques - Important surgical practices include:
** minimization of tissue handling
** use of delicate instruments
** use of magnification
** constant wetting of all tissues
These principles are important to keep the formation of adhesions to a minimum.
Due to the inevitability of adhesion formation, surgeons have concentrated their efforts on intervening at varying points in the pathway of adhesion formation.
As a result, the use of various adjuvants has been employed to reduce adhesion formation. These agents can act at one or more of the stages of adhesion formation. There are several ways to try to impact on the formation of adhesions either with chemical methods or barrier methods. 2.) Chemical Methods The use of various drugs has been evaluated in an effort to reduce the postoperative incidence of adhesions. To date no well-controlled study has documented the efficacy of these drugs.
3.) Barrier methods The use of a barrier between raw tissue surfaces appears to be one of the most promising methods of adhesion prevention. Barriers mechanically separate the surgical surfaces and keep those surfaces apart. The first surgical adjuvant specifically indicated for the reduction of adhesions in gynecologic pelvic surgery over raw services has been approved by the Food and Drug Administration in the United States.
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