Re: Adhesions: What -- Why -- Where -- What to do

From: Helen Dynda (olddad66@runestone.net)
Tue Nov 16 19:20:41 1999


Amy,

1.) What are adhesions?

Adhesions are fibrous bands connecting structures that are normally separate. Adhesions develop as normal tissue responds to some form of injury.

2.) 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.

3.) Why do adhesions form?

a.) *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.

b.) 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.

c.) *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.

d.) *Hemorrhage* or bleeding brings blood products into the operating field.

e.) The *raw surfaces* from the operation plus the blood from tissues can enhance the formation of adhesions.

f.) *Infection* from a variety of sources, endometriosis, or pelvic inflammatory disease can cause inflammation which results in adhesion formation.

4.) Where do adhesions form?

Adhesions are common and can form on any surface in the pelvis and abdomen after surgery. Some organs, though, are more likely than others to develop adhesions. The ovary, pelvic sidewall, and fimbria are the most common sites for adhesion formation.

5.) What can be done to prevent adhesions?

a.) Microsurgical techniques -- Surgeons have developed microsurgical techniques that minimize trauma, ischemia, foreign bodies, hemorrhage, raw surfaces and infection to reduce adhesion formation.

What are some of these microsurgical techniques? Important surgical practices include: minimization of tissue handling, use of delicate instruments, use of magnification, and constant wetting of all tissues.

b.) Chemical methods -- Various drugs have been evaluated in an effort to reduce the post-operative incidence of adhesions. To date, no well-controlled study has documented the efficacy of these drugs.

c.) Barrier Methods -- The use of a barrier between raw tissue surfaces appears to be one of the most promising methods of adhesion prevention. Barriers, such as Interceed and Seprafilm, mechanically separate the surgical surfaces and keep those surfaces apart. Unfortunately, both of these barriers have not proven to be very successful in preventing adhesions.

d.) Gel-adhesion barriers -- Clinical trials of gel-adhesion barriers, such as Intergel, have been underway throughout the United States this past year. These gel barriers are already being used in surgery by surgeons in Europe and Canada. Hopefully, in another 6-8 months, the FDA will be ready to determine if Intergel is ready to be approved for use in surgery in the United States.

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The above information is found at the following web site:

http://www.adhesions.org/patient.html

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At Mon, 15 Nov 1999, Amy Wellman wrote: >
>Hi I am having alot of trouble with adhesions and would like to talk to someone........please email,,,,,,,,,,,,,,sad@wmis.net. my name is Amy

--
The 15th century proverb which summarizes the purpose of medicine is:
* To cure sometimes, to relieve often, to comfort always. *

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