Laparoscopic Adhesiolysis

Adhesiolysis is a surgical procedure performed to divide or remove adhesions to assist in the restoration of normal anatomy and organ function and also to relieve its painful symptoms.

What are adhesions?

The formation of adhesions is part of normal healing process, but in some scenarios, it can result in the development of excessive scar tissue, unequal to the original injury.

These adhesions can join your tissue or organs together, in a manner which can cause organ dysfunction, pain and other related symptoms. As a result, a patient can be required to undergo laparoscopic adhesiolysis surgery, which is a minimally invasive surgical procedure to remove  adhesions.

Indications for laparoscopic surgery for adhesiolysis

Generally, patients with adhesions rarely experience symptoms. But in severe cases, adhesions cause pain by pulling nerves, within the adhesion itself or within an organ tied down by adhesions.

Patient selection is very critical for laparoscopic adhesiolysis surgery to succeed. Lap adhesiolysis surgery has some potential benefits, which can only be achieved if the surgery is performed to patients who are best suited to it. Laparoscopic adhesiolysis surgery is indicated for the following patients:

• Patients with either partial or complete small-bowel obstruction not healing through non-operative procedures, but without signs of ischemia, bowel perforation or peritonitis.
• Patients whose bowel obstruction is resolved, but it has a history or recurring and chronic small-bowel obstruction indicated by a contrast study.
• Liver adhesions which cause pain while breathing
• Intestinal adhesions which cause pain when exercising or stretching
• Diminished fertility as a result of adhesions

However, there is an existing controversy of whether laparoscopic surgery for adhesiolysis can benefit patients with chronic pelvic pain. But, sometimes the surgery can be performed in patients with chronic pelvic pain if no other symptom is discovered during the previous surgery.

How is the surgery performed? The 30° telescope used in most surgeries assist the surgeon in inspecting the abdominal organs as well as peritoneal cavity easily. The secondary ports should be introduced under laparoscopic vision. The surgeons use finger indentation of the parietal peritoneum to identify the selected site of the abdominal wall.

If the doctors suspect extensive adhesion, they can use the open technique for trocar insertion. During lap adhesiolysis surgery, the surgeon should be very gentle with bowel and the tubal structure to avoid re-adhesion forming again and prevent stricture formation.

Thin and avascular adhesions can be easily lysed, and there are minimal chances of the adhesions reoccurring again. However, thick and highly avascular adhesions are very difficult to separate. Therefore, such adhesions require the surgeon to use an energy ultrasonic dissector. The surgeon then introduces atraumatic grasper to hold the adhesion. The adhesion should be stretched carefully to assist in the identification of the adhesion boundaries. A close-up magnified view of the telescope helps the surgeon to choose the avascular area. The surgeon then uses the opposite trocar, close to him or her, for scissors, and the adhesion are dissected. An electrosurgical instrument should be used to coagulate vascular adhesions.

Advantages of doing laparoscopic surgery for adhesiolysis

The advantages of laparoscopic adhesiolysis surgery include:

• Shorter recovery time
• Faster return to normal activities
• Shorter hospital stay
• Less pain from the surgery
• Less visible scars

Side effects or complications of lap adhesiolysis surgery

Like any other surgical procedure, lap adhesiolysis surgery has complications, even though they are not common.  Some of the complications include:

• Bleeding and wound infection
• Small risk of intestinal injuries.
• Injury to the bowel.

Post-operative care after adhesiolysis surgery

How soon a patient is allowed to take liquids and eat food after laparoscopic surgery for adhesiolysis depends on the extent of the surgery. Generally, patients are allowed to take liquids after adhesiolysis surgery once they start passing flatus. A patient can experience nausea in the first 12 to 16 hours after the surgery, but it passes away soon.

After adhesiolysis surgery, the patient will experience some pain in the incision sites for a few days, but the pain is usually less compared to open surgery. The doctor gives a prescription of pain medication to manage the pain. Patients are encouraged to get out of bed soon after the surgery despite the slight pain. The pain reduces gradually over a period and becomes almost insignificant.

The time a patient takes before resuming their usual activities depends on the type of adhesiolysis surgery. Most patients can walk within the first 6 hours of surgery. They usually get back to work within a week’s time.

Cost of Adhesiolysis surgery

The average cost of laparoscopic surgery for adhesiolysis depends on various factors. However, lap adhesions surgery cost is determined by factors like demographic location of the patient, hospital and the room type selected. Adhesiolysis surgery cost for women tends to be higher than laparoscopic adhesiolysis surgery cost for men. Also, some insurance companies cover adhesiolysis surgery cost while others do not cover laparoscopic surgery for adhesiolysis cost.