Postoperative adhesions, or scar tissue that forms after surgery, can lead to severe complications. Understanding adhesion prevention and how surgeons can minimize postoperative scar tissue formation is crucial for better patient outcomes.
At The Surgical Clinic, we want to provide you with further insights into what strategies, surgical techniques, and medicines surgeons use to prevent adhesions.
What are Postoperative Adhesions?
Simply put, postoperative adhesions are defined as scar-like tissue that forms internally between structures or organs that are not normally connected. For example, in the pelvic region, organs like the uterus, ovaries, and bladder are close to one another, but not directly connected. For surgeries in this area, postoperative adhesions can form between these organs, leading to extreme discomfort and complications for patients.
Adhesions like this are typically a result of:
- Surgery
- Infection
- Inflammation
How Postoperative Adhesions Form
Postoperative adhesions can form following a major surgery to the abdomen, pelvic region, or rectum. They can also form from trauma or infection to the body. During the healing process following a surgical procedure, your body will create scar-like tissue internally to essentially close the wounds. However, this production of scar-like tissue can spread to other internal organs close to the surgical site creating “bridges” – scar-like tissue adhering from one organ to another.
It’s important to note that postoperative adhesions are similar to scar tissue in the sense that both produce a fibrous connective tissue during healing, but the former forms internally between organs or tissues.
Postoperative Adhesion Symptoms
Post scar tissue following a surgical procedure will not cause symptoms. However, in some cases of internal abdominal adhesions, there can be following symptoms:
- Cramping
- Bloating
- Nausea and vomiting
- Blood in stool
- Pain in abdomen, mainly near the incision site
These symptoms are due to the adhesions creating small obstructions in the bowel.
Most Common Surgeries That Can Cause Postoperative Adhesions
The two most common surgeries where postoperative adhesions occur are abdominal and pelvic surgeries. More specifically:
- Laparotomies, also known as an open surgery on the abdomen
- Lower digestive surgery such as on the colon or rectum
- Endometriosis surgery
- Ovarian cyst removal
- Uterine fibroid removal
Risk and Complications of Postoperative Adhesions
These adhesions can lead to severe health issues and complications like:
- Small bowel obstructions
- Chronic pelvic pain
- Complications with future surgical procedures
- Female infertility
Complications like these not only bring pain and discomfort to patients, but they can also warrant additional surgeries for needed treatment.
However, there are two types of risk factors associated with the development of postoperative adhesions including:
Surgical
- Open abdominal surgery and pelvic surgery
- Prolonged manipulation of the tissue during surgery
- Incorporation of foreign objects like mesh during surgery
- Prolonged length of surgical time
Patient
- History of abdominal or pelvic surgeries
- History of endometriosis
- Obesity
- PID (pelvic inflammatory disease)
- Chron’s disease
- A genetic disposition to development of adhesions
Treatment Approaches to Reduce Adhesions
Strategic surgical techniques are vital in adhesion prevention during postoperative recovery. Employing less invasive techniques and careful tissue handling can significantly reduce the risk of adhesions. Below are additional surgical approaches surgeons look to in order to reduce the risk of their patients developing postoperative adhesions.
Minimally Invasive Surgery
Laparoscopic surgery, a minimally invasive surgical procedure, uses smaller incisions that significantly reduce tissue trauma and postoperative adhesions. These smaller incisions also lower the risk of adhesions by reducing foreign material exposure. This technique minimizes tissue trauma and decreases the likelihood of adhesion formation.
Beyond reducing adhesions, laparoscopic surgery offers shorter recovery times, less postoperative pain, and lower risks of complications like small bowel and intestinal obstructions. As a result, it has become a preferred method for surgeons for various abdominal and pelvic procedures.
Gentle Tissue Handling
Careful tissue handling and minimizing unnecessary force during surgery are crucial for preventing scar formation and internal scar tissue. Surgeons must use gentle tissue manipulation to avoid causing additional trauma to surrounding tissues, ensuring better healing outcomes. Not only does gentle tissue handling reduce the risk of scar tissue development, but also improves patient recovery overall.
Use of Adhesion Barriers
Adhesion barriers are substances applied between tissue layers during surgery to prevent them from sticking together as they heal. These barriers, available as films, gels, or fabrics, reduce the risk of adhesion formation by separating traumatized tissue surfaces. Common FDA-approved adhesion barriers include Seprafilm, Interceed, and Adept, often used after abdominal or pelvic surgeries.
These barriers typically dissolve and are absorbed by the body within a week after surgery.
Effective use of adhesion barriers requires careful selection based on the type of surgery and the patient’s specific needs. Proper implementation can significantly reduce the risk of postoperative adhesions, improving patient outcomes and reducing healthcare costs.
Management and Treatment Options for Postoperative Adhesions
Unfortunately, adhesions following a surgical procedure can still occur despite proper surgical approaches. However, there are additional treatments that can help treat scar tissue following surgeries.
NSAIDs and Anti-Inflammatory Drugs
Since inflammation can also trigger postoperative adhesions, your doctor may suggest taking NSAIDs and anti-inflammatory drugs to lower the risk of adhesions. NSAIDs, like Aspirin and Ibuprofen work by blocking the chemicals in the body that produce inflammation. While decreasing inflammation, these medications also decrease pain caused by inflammation in the body. Talk with your doctor before your surgery to see which NSAIDs are right for you following your procedure.
Estrogen Therapy
Medical professionals have identified the hormone estrogen as a potential inhibitor of adhesion formations post-surgery.. Estrogen therapy can be applied topically or systematically and works by speeding up the wound healing process and decreasing inflammation. Since estrogen levels fluctuate throughout a woman’s cycle, incorporating estrogen levels as a form of therapy following a surgical procedure can be beneficial. Including estrogen can also increase the secretion of growth hormone ultimately helping with wound healing.
However, there is still much research being done on estrogen therapy’s effectiveness in treating and preventing postoperative adhesions. Your provider will be able to determine if it is safe and appropriate to introduce additional estrogen to your body for this purpose.
Physical Therapy
Manual therapy can effectively enhance organ mobility, potentially reducing adhesion risk. Physical therapy can provide significant symptom relief for patients with adhesion-related bowel obstructions with specific techniques to loosen adhesions and improve overall abdominal function. PT can also bring blood flow to the area, while also helping regain strength and range of mobility. Incorporating physical therapy following an abdominal or pelvic procedure can lead to quicker healing, recovery, and a possible reduction in adhesion-related complications.
Postoperative Adhesion FAQs
How Long Do Postoperative Adhesions Last?
Postoperative adhesions can develop in the days following surgery and can last from a few months to years.
Can Postoperative Adhesions be Massaged Away?
No, postoperative adhesions can not be massaged away, but therapy approaches like manual massages can help with softening and stretching the scar tissue to help with circulation.
Can Exercise Help with Postoperative Adhesions?
Yes! Exercise therapy can help, such as:
- Stretching
- Pelvic floor exercises and therapy
- Walking
- Core strengthening exercises
Exercises like these help to circulate the blood, which in turn helps with pain that postoperative adhesions can create and aids in improving organ function.
Are All Postoperative Adhesions Internal or External?
Since all postoperative adhesions form within the body cavity, this makes them internal.
Can Imaging Detect Postoperative Adhesions?
Imaging like CT scans, ultrasounds, or MRIs typically are unable to detect postoperative adhesions, but they can detect complications from these adhesions like obstructions in the bowel.
Postoperative Adhesion in Review
Ultimately, postoperative adhesion formation is a significant concern in surgical recovery, leading to complications and additional healthcare costs. Understanding the mechanisms of adhesion formation and employing effective prevention strategies are crucial for improving patient outcomes.
Surgical techniques, pharmacological interventions, and physical therapy can all play a role in reducing the risk of adhesions and its complications.
By staying informed and proactive, patients and healthcare providers can work together to minimize the impact of adhesions and ensure better recovery experiences.
With continued advancements and a commitment to best practices, the future of adhesion prevention looks promising.
Minimally Invasive Surgery at The Surgical Clinic
At The Surgical Clinic in Nashville, TN, we strive for improved surgical outcomes and a higher quality of life for patients. We do this through a patient centered surgical approach by utilizing minimally invasive techniques such as laparoscopic surgery. Patient care and comfortability before, during, and after a surgery is paramount. And our team is dedicated to going above and beyond to ensure each patient receives top care for the sake of overall health and successful healing.
Contact us today to find our nearest location to you, and learn more about how The Surgical Clinic can assist you with any of your surgical or medical needs.