The severe consequences

of

Adhesion Related Disorders

Pelvic Adhesions are bands of fibrous scar tissue that form in the abdomen and pelvis, usually after surgery. Adhesions connect organs and tissue that are normally separate, ovaries, fallopian tubes, bladder or bowel can be affected. Adhesions can also lead to a variety of severe complications including chronic pelvic pain, infertility and bowel obstruction.

Adhesions start forming almost immediately after surgery as part of the normal healing process to repair raw tissue. Unfortunately In the process some organs/tissues become "stuck" to adjacent tissues and thus cause pain.

Adhesions also develop as normal tissue responds to some form of injury.In many cases these Adhesions are painless and the patient never knows she has them, while in other cases they cause a sharp, pulling type of pain, or pain with intercourse or bowel movements.

Pelvic Adhesions can be filmy (kind of like sheets of cling film), or thick. Some contain small blood vessels. If they involve the fallopian tubes, they can cause infertility or lead to tubal (ectopic) pregnancies. If they are above the liver they can cause pain with deep breathing. If near the vagina, there can be pain with intercourse. And, if they involve the intestines, there can be pain with exercising, reaching for objects above one's head, or when stretching.

Adhesions involving the female reproductive organs, the ovaries, fallopian tubes, etc can cause dyspaareunia (painful intercourse) infertility, over 40% of all infertility problems are related to Adhesions.

Adhesions are believed to cause pelvic pain by tethering down organs and tissues. It is not unusual for several organs to be adhered to each other, causing traction (pulling) of nerves. Nerve endings may also become entrapped within a developing Adhesion causing severe pain.Also if the bowel becomes obstructed, distensions will cause pain.

Surgical procedures most commonly associated with Adhesion formation are, ovarian cystectomy, myomectomy, total abdominal hysterectomy, salpingostomy / fimbrioplasty, excision of endometriosis, excision of eptopic pregnancy, cesarean section, and adhesiolysis.

Adhesions can form elsewhere such as around the heart, spine and in the hand where they may lead to other problems. Adhesion related disorders (ARD)

Following reproductive pelvic surgery performed by laparotomy, 55% to 100% of patients are shown to have Adhesions at subsequent surgeries. The number of hospital readmissions for Adhesion related complications rival the number of operations for heart bypass, hip replacements and appendix operations.

Intesttinal obstruction is one of the most severe consequences of Adhesions. 30-41% of patients who require abdominal reoperation have Adhesion-related intestinal obstruction. Adhesions involving the bowel can cause a bowel obstruction or blockage.

For small-bowel obstruction, the proportion rises to 65-75°I0.7'' The clinical consequences of Adhesions are not confined to the gut; Adhesions are a leading cause of secondary infertility in women, and can cause substantial abdominal and pelvic pain.

Adhesions can lead to a variety of complications. A study involveing 120 patients undergoing reoperative laparotomy, estimated an increase of 24 minutes in total time of operation, because of intra-abdominal Adhesions from a previous surgery. A 21% risk of Adhesion related bowel perforation was identified in 274 patients undergoing relaparotomy.

The rate of Adhesion formation after surgery is surprising, given the lack of knowledge about Adhesions, among doctors and patients alike. The lack of epidemiological data on Adhesions, combined with an inability effectively to prevent Adhesion formation has limited the impetus to investigate this disorder.

The first step towards treatment is of course diagnosis, and your doctor will take a history, examine you and possibly conduct some tests, in an attempt to determine if your problems are Adhesion related. These tests may include a laparoscopy.

For reasons stated above, adhesiolysis may not be the answer and may not even be the first choice. I would certainly ask your doctor if s/he might consider an adhesiolysis. If s/he was able to use one of the Adhesion barriers now available, s/he needs to read the product label to determine whether it is appropriate.

A great deal of effort has been dedicated to reduce Adhesion formation. A number of steps can be taken to minimize the risk of Adhesions, including good surgical technique.

Techniques to prevent or reduce Adhesion formation these include - Gental use of tissue handling - Use of delicate instruments/microsurgical techniques - Constant irrigation - Meticulous hemostasis - Removal of all foreign materials - Suturing without significant tension - Mecanical barriers to separate raw surfaces.

If extensive adhesiolysis surgery is required, often a general surgeon will be asked to collaborate with the gynaecological surgeon.

If an endometriosis site is discovered and removed, this should also be covered with an adhesion barrier.

As well as drug treatments, physical therapy, exercise and dietary changes are sometimes nessesary. In extreme cases where bowel function is disturbed, comprehensive nutritional support is a necessity.

Adhesions are almost an inevitable outcome of surgery, and the problems that they cause are widespread and sometimes severe. It has been said by some that Adhesions are the single most common and costly problem related to surgery, and yet most people have not even heard of them. This lack of awareness means that many doctors are unable or unwilling to tackle the problems of Adhesions.

Adhesions and ARD are conditions that are not clearly recognised nor understood and for those who are suffering it is often a very lonely existence. There is a great need to raise the level of awareness among doctors, healthcare providers, government, and the public as a whole, to prompt a more comprehensive and integrated care system for ARD sufferers.

Patients suffering from Adhesion Related Disorders are often sentenced to the frustrating ordeal of having to find experienced and accessible healthcare for their condition.

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