I frequently see patients in my office who present the complaint of abdominal pain. There are many causes of abdominal pain, but in those patients who have had previous surgery, the possibility of intra-abdominal adhesions must always be considered. Adhesions are strands of tissue the body forms in response to an injury, in this case usually surgery, that adhere to and pun on the bowel or other structures. This pulling or traction causes pain. In fact, patients often; complain about a pulling sensation in their abdomen. Intra-abdominal infection or radiation exposure may also result in adhesions.
Everyone is different in the way their body acts in response to surgery. Some people will form extensive adhesions, while others having the same surgery win form very few adhesions or even none at all.
It is impossible to determine 'who will have problems with adhesions after a procedure, though if a patient has had adhesions with previous surgery it is likely they will occur again. It is exactly for this reason that surgeons were hesitant prior to the advent of laparoscopy to operate on abdominal pain which was due to adhesions. D There was a strong possibility that with open surgery the patient may have no improvement and may have even worse pain than prior to surgery. Consequently, in the past, the only reason a patient would have surgery related to the adhesions was for a bowel obstruction or for pain so intracable that a surgeon would operate in hopes that the situation would not be worsened by the procedure.
Today, the advent of laparoscopic surgery has been a great benefit to those patients with symptomatic adhesions who continue to have chronic pain. Initially, the pain from adhesions can be treated with oral medications. Generally, a non-steriodal anti-inflammatory (NSAID) medication with as Motrin, Advil or Naprosyn is used. About 50 percent of people have a satisfactory response with medicine alone. Those who do not respond to a six-week course of medical therapy are candidates for surgery.
In most cases the operation is performed on a outpatient basis. An inspection of the abdominal cavity can be made though several small incisions much like those used for a gallbladder operation. Various types of instruction can be inserted including the harmonic scalpel to divide the adhesions and allow the bowel to assume a more natural position in the abdominal cavity. As there is no traction on the bowel, the patients have less pain and bloating. Frequently, diarrhea or constipation may also be resolved.
The significant advantage of the laparoscopic approach, is that the adhesions rarely recur as they do with an open operation. Thus, unlike in open surgery, the benefit of surgery seems to be more durable and the recurrence of pain is quite small. I have performed a number of these operations and only two patients have reported less than excellent results.
In summary, adhesions can occur for many reasons, the most common cause is previous abdominal surgery. Adhesions tend to cause symptoms of bloating, abdominal pain, and abnormal bowel movements. Though about half of all patients respond to medical therapy, laparoscopic surgery has proved to be of great benefit to those patients who continue to have pain related to adhesions.
[ FAQ | About Your Surgeon | Special Topics ]