>----- Original Message -----
From: Helen DyndaSent: Friday, May 03, 2002 2:46 PM
To: Multiple recipients of list ADHESIONS
Subject: How are abdominal adhesions from laparoscopic gallbladder surgery diagnosed and treated?
How are abdominal adhesions from laparoscopic gallbladder surgery diagnosed and treated? -- Enter: "Adhesions" in the Search box and click: "Search" -- Scroll down to this article.
http://www.intelihealth.com/IH/ihtIH One of the compelling advantages of laparoscopic cholecystectomy over the more traditional approach is the markedly decreased formation of adhesions (scar tissue) that follows this type of surgery. Adhesions are bands of scar tissue that develop within the abdomen around the places where surgeons have needed to cut and sew. By limiting cutting and handling of internal organs during surgery, adhesions are less likely to form. When the abdominal wall is opened through a long incision there is greater chance for scar and adhesion formation. Nevertheless, even the minimal injury that is caused during laparoscopic gallbladder surgery provokes an adhesion response, but because the surfaces of the abdominal contents are kept moister, and because there is less bleeding, there are measurably fewer adhesions. Unfortunately, the diagnosis of adhesions cannot be done by typical laboratory or radiologic studies. In other words, there are no X-rays or tests that demonstrate these adhesions. The adhesions themselves can be quite thin and difficult to detect under normal situations. Historically, adhesions were only thought to be a problem if they caused mechanical obstruction to the intestines. If a mechanical blockage occurred it would be evident by abdominal distention and, if untreated, nausea and vomiting. Recent evidence, supported by several studies in the literature, suggest that some patients with adhesions may have chronic, ongoing abdominal pain that may respond to laparoscopic exploration and division of the adhesive bands. There is no way to predict which patients will have a symptomatic improvement in these situations. Overall, approximately 65 percent to 70 percent will experience a relief of their symptoms. Because there are no specific tests for adhesions, the only way they can be diagnosed and visualized is by actually looking into the abdomen. This can be accomplished one of two ways: an "open" exploration or laparoscopy. An "open" exploration would be counterproductive because even more adhesions could develop. Laparoscopy is an appealing alternative because the procedure can be done on an outpatient basis, it can both diagnose and treat problems and it can identify unrelated pathology. Therefore, if a patient has sufficient upper abdominal symptoms to raise the question of adhesions, an exploratory laparoscopy is ultimately the best method of confirming the diagnosis.Get more from the Web. FREE MSN E