LySIS OF ADHESIONS

 

In April of 2008, Camille underwent a surgery called a Lysis of Adhesions due to repeated small bowel obstructions.  Her first small bowel obstruction occurred in 2005, during which time, she also required this surgical intervention.  

There are two different ways the surgery can be performed, either as a laparoscopy (the doctor makes small incisions in the wall of your abdomen using a fiberoptic instrument to see inside) which is most common, or as a laparotomy (an open abdominal surgery).  Due to Camille’s condition, they had to perform an open abdominal surgery (laparotomy) where a larger incision was made in the abdomen, from her sternum to navel, to allow the surgeon direct access to all the organs.  This is the traditional approach to the surgery which allows for greater precision but has a substantially longer recovery time and more postoperative pain.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Left: a normal peritoneum, the transparent membrane that wraps the pelvic and abdominal organs. Right: after surgical trauma, fibrous bands of collagen grow as part of the normal healing process and form adhesions. Adhesions connect tissues or structures that are normally separate. Adhesions in the abdomen or pelvic area can lead to infertility, pelvic pain, small bowel obstruction, or the need for repeat surgery.

 

Actual photos from Camille’s surgery

 

 

 

 

 

 

 

 

 

 

 

Left: View from Scope: dilated loops of bowel & stomach wall

Right: View from Scope: dilated loops of bowel (small intestines)

 

 

 

 

 

 

 

 

 

 

 

Left: Intestines resting on Camille's stomach (dilated and undilated loops of bowel)

Right: Surgeon's hands & Camille's Intestines (dilated and undilated loops of bowel)

 

 

Small Bowel Obstruction

A small-bowel obstruction (SBO) is caused by a variety of pathologic processes. The leading cause is postoperative adhesions. SBOs can be partial or complete, simple or strangulated. Strangulated obstructions are surgical emergencies. If not diagnosed and properly treated, vascular compromise leads to bowel ischemia and further morbidity and mortality. Because as many as 40% of patients have strangulated obstructions, differentiating the characteristics and etiologies of obstruction is critical to proper patient treatment.  Obstruction of the small bowel leads to proximal dilatation of the intestine due to accumulation of GI secretions and swallowed air.  Vomiting occurs if the level of obstruction is proximal. Increasing small-bowel distention leads to increased intraluminal pressures. The fluid loss and dehydration that ensue may be severe and contribute to increased morbidity and mortality.  Strangulated SBOs are most commonly associated with adhesions and occur when a loop of distended bowel twists on its mesenteric pedicle. The arterial occlusion leads to bowel ischemia and necrosis. If left untreated, this progresses to perforation, peritonitis, and death.

 

What is Lysis of Adhesions?

Lysis of adhesions is the process of cutting scar tissue within the body to restore normal function or appearance.

 

Reasons for Procedure

Adhesions are scar tissue that forms within the body, usually within the abdomen or pelvis. Adhesions develop naturally after surgery as part of the healing process. Adhesions can also develop after infection or any other inflammatory process such as :: endometriosis, :: diverticulitis, or :: appendicitis. Adhesions can cause pain, obstruction of the bowel, and infertility. Cutting the adhesions may stop or reduce these problems.

 

What to Expect Prior to Procedure

Your doctor will perform a physical exam and will probably order some of these tests:

•Blood Tests

•:: Ultrasound—a test that uses sound waves to visualize the inside of the body

•:: CT Scan—a type of x-ray that uses a computer to make pictures of the inside of the body

•:: MRI Scan—a test that uses magnetic waves to make pictures of the inside of the body

 

In the days leading up to your procedure:

•Review your regular medications with the surgeon; you may need to stop taking some drugs.

•Arrange for a ride to and from the procedure.

•The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.

•Wear comfortable clothing.

 

Description of the Procedure

In open abdominal surgery (laparotomy), you will receive a general anesthetic, and a larger incision will be made in the abdomen to allow the surgeon direct access to all the organs. It is not unusual for a laparoscopy (using a fiberoptic instrument to see inside) to be converted to a laparotomy during the same operative session.

 

How Long Will It Take?

The surgery will take between 1 to 3 hours.

 

Will It Hurt ?

The injection of local anesthetic may sting or burn. The procedure itself usually does not hurt. You may experience soreness for a couple of days during recovery, but you will receive pain medication to relieve this discomfort. If a laparotomy has been performed, you will have more pain, and the surgeon will give you more pain medicine.

 

Possible Complications

Injury to the following:

•Bowel

•Bladder

•Blood vessels

•Ureters (tubes that carry urine from the kidney to the bladder)

           •Worse adhesions

           •Bleeding

           •Infection

 

Average Hospital Stay

You may or may not stay overnight, depending on the extent of surgery. Open laparotomy will usually require up to a week in the hospital.

 

Postoperative Care

When you return home after the procedure, do the following to help ensure a smooth recovery:

•Follow your doctor’s instructions for care of the incision site.

•Take pain medications as directed by your doctor.

•Avoid heavy lifting.

•Do not drink carbonated beverages for two days.

 

Outcome

Cutting adhesions can fix intestinal blockage and treat infertility caused by adhesions. The procedure reduces chronic abdominal pain in about 45% of individuals.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

•Signs of infection, including fever and chills

•Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site

•Cough, shortness of breath, chest pain, or severe nausea or vomiting