Adhesions after laparoscopy: symptoms, prevention, treatment
Endoscopic technique is very firmly entrenched in routine practice of surgeons. Laparoscopy today can rightly be considered the gold standard in the diagnosis of a large number of diseases. This method allows to minimize the traumatic effects on the skin and internal organs of the abdominal or thoracic cavity.
But, besides the obvious advantages of laparoscopic method of research has a significant disadvantage. In the implementation of a number of factors are developing adhesions after laparoscopy. Very often it becomes a morphological substrate for the occurrence of adhesive disease.
The urgency of the problem
Spike is a organized sites of fibrin. They turn into connective tissue structures, which, depending on localization can cause various disorders. For example, after the formation of adhesions in the region of the fallopian tubes is infertility (tubal). If these bands are defined between the abdominal organs, that may result in chronic pain syndrome or even mechanical intestinal obstruction.
The true incidence of patients with the formation of adhesions is difficult to determine. It is not always this pathology will manifest itself clinically. Then to detect the presence of adhesions is not possible.
In some percentage of cases the pathology occurs with characteristic clinical manifestations. It is believed that about a quarter of patients after laparoscopic surgery suffer from adhesions illness. That is why the problem is quite relevant. This dictates the need for adequate prevention of the development of adhesions.
If the patient has made a study of laparoscopic or surgery with curative intent, had not always formed the connective tissue bands. Especially not in each case, when adhesions will develop adhesive disease. This means that there is a certain predisposition. It is implemented in persons with diabetes, elderly patients. The regenerative ability of the tissues significantly reduced in comparison with healthy people. Therefore, the deposition of fibrin may be accompanied by the accession of allergic or autoimmune mechanisms.
A predisposing factor in the development of adhesions can be considered a mechanical failure sheets of peritoneum.
Laparoscopy involves minimal risk to the implementation of this factor. However, taps of the endoscope and friction on the peritoneum can not be avoided in any way. This can cause the formation of adhesions only in the region of the ongoing invasion.
Next possible cause is the contact with air. Laparoscopy, performing diagnostic purpose also involves the use of pneumoperitoneum. We are talking about filling the abdominal cavity gas composition. It is necessary for a clear visualization of pathological changes of organs and their structures. In such conditions, the peritoneal sheets are unusual. It may therefore be «over-drying».
Infection is another factor that provokes adhesions. Laparoscopy in diseases of the pelvic organs is often fraught with what is happening translocation of infectious agents from one area to the area of endoscopic intervention. The bacteria thus fall on fertile ground – nutrient strands or sheets of fibrin. Quickly multiply in an anaerobic environment, they lead to purulent lesions of organs and constrictions, which hampers tissue regeneration and leads to a bright manifestations of adhesive disease. If the area of intervention of the bacteria was not originally, they can be placed with endoscopic technique failure to comply with the necessary requirements.
Possible consequences and complications of commissural process
By themselves, adhesions without clinical symptoms are not considered dangerous. Therefore, asymptomatic not an indication for surgical intervention.
But there are really dangerous condition caused by the formation of connective tissue bridges.
Laparoscopy often leads to spikes between the intestinal loops. This can significantly disrupt the passage of intestinal chyme. Surgeons have noted that adhesions is the most frequent factor of occurrence of such a terrible condition, like mechanical bowel obstruction. Very often this disease with inadequate or delayed treatment leads to infectious-toxic shock, sepsis. These complications are very hard to oversee even the most equipped with intensive care.
Less dangerous is a painful form of adhesive disease. This can disrupt the function of internal organs. Pain comes to the fore among all the other clinical manifestations. Connection of various types of dyspepsia. Patients will complain of belching air, bursting in the stomach, heartburn, violations of the chair.
This form of pathology is not fraught with immediate danger. However, chronic pain syndrome affects the quality of life and satisfaction with it. As a consequence, often the appearance of the signs of depression and other mental changes. Symptoms can interfere with work, personal and family life.
Approaches to treatment and prevention
For the treatment of asymptomatic existing adhesive bands, you can try conservative methods. For a start it can be physical therapy, the use of drugs. With the ineffectiveness at the request of the patient may be relaparoscopy (repeated invasive procedures) and removal of adhesions.
Chronic pain form is treated conservatively. It is important to use a local impact. Therefore, great importance is attached physiotherapy methods. Apply heat when ozokeritotherapy, paraffin, UHF. Very effective conducting electrophoresis with absorbable drugs. These include iodides and Lidetu. Medical therapy is symptomatic.
In intestinal obstruction the patient’s condition is stabilized and urgently begin to evaluate the viability of the intestine. If it is violated, it is necessary to do a resection with the capture of healthy tissue.
Prevention of disease includes the observance of all rules of this procedure. It should not be traumatic. In the appointment of this technique, you should evaluate the regenerative capacity of the tissues of the patient.
To prevent the formation of connective tissue bands can be proactively and locally irrigating the region of the field fibrinolysin. After surgery as early as possible, you should assign physical therapy, is not yet finally organized fibers of fibrin.