Treatment of Adhesions
Despite doubts as to the relationship between ADHESIONS
and pain, several studies show that lysis (cutting,
of ADHESIONS provides some relief.
In a study in Germany (Frey et al., 1994) 58 (40 female,
18 male) patients with chronic abdominal pain underwent
laparoscopy. Other than adhesions, there were
no abnormal findings. The ADHESIONS were then
cut (adhesiolysis) and the patients pain was assessed
up to 30 months later. There was a complete remission
of pain in 45% of the patients, with 35% of patients
reporting a substantial improvement. Pain persisted
in 205 of the patients. Similar figures were reported
by a Swiss group (Mueller et al., 1995). American
surgeons such as Steege and Stout (1991) and Daniell
(1989) have also reported improvement in pain after
adhesiolysis. In a Dutch study (Peters
et al., 1992), only patients with chronic pelvic
pain and severe adhesions benefited from adhesiolysis.
If there is an underlying cause of adhesions, such
as endometriosis or infection, then clearly this must
be treated. A full discussion of endometriosis
is well beyond the scope of this paper, and I thoroughly
recommend visiting the Endometriosis
Society web site for more information.
The problem with adhesiolysis is that ADHESIONS almost
always reform, and so the procedure is sometimes self-defeating.
This is one of the main reasons why surgeons are reluctant
to perform adhesiolysis, particularly in severe cases.
In addition, the presence of adhesions makes surgery
more hazardous, because of the risk
of injury to the bowel, bladder, blood vessels and ureters.
As we have seen, some patients may have periods of relief
from and/or bowel obstruction for several months, only
to have the problem recur, as in this email I received:
I have come back from the [Famous Hospital],
the GI specialist said that they were 10
- 12 years from knowing how to treat this
problem. I still run into alot of MD's who
say adhesions don't cause pain, but since
I have had 7 surgeries and each time adhesions
are "taken down" I get about 1
years worth of pain relief. I have even
showed them research studies that show a
decrease in pain s/s after surgery and they
still are skeptical. Anyway, they are sending
me to a Dr. XXXX who supposedly specializes
in this kind of pain. I hope to have an
appointment at the end of April. I'll let
you know how it turns out. Keep me informed
of any developments that might be helpful
with my case. Thanks"