Massage of postoperative adhesions.

What's happened postoperative adhesions and where do they come from? This is tissue that has grown between organs and connects them. Adhesions come in the form of films, scars, scars, threads of the most intricate shapes. They are formed during inflammatory processes, both after surgery and as a result of infectious diseases. This is how the body reacts to external stimuli. The growing tissue should probably additionally support the organ or serve as some kind of auxiliary attachment of the organ in abdominal cavity. But as a result, adhesions limit the elasticity and mobility of internal organs, for example, they make it difficult for food to move through the intestines and can even cause acute obstruction. In milder cases, adhesions periodically or constantly cause discomfort, lead to bloating and cramping or aching pain. Patients experience intolerance to rough, poorly digestible food, a tendency to constipation, decreased ability to work, and fatigue.

Many women, as a result of abortions or sexually transmitted diseases, suffer from adhesions of the reproductive organs, which, in turn, leads to difficulty in the movement of the egg and ultimately to infertility.

Sometimes adhesions resolve on their own after the inflammatory focus disappears, but more often they need to be removed, since over time the adhesions become rough, dense and look like scars that arise in places of mechanical damage to the skin.

Many doctors recommend surgical removal of adhesions. But the paradox is that the more surgical interventions, the higher the likelihood of adhesion formation. So the effectiveness of this method is very doubtful.

To prevent adhesions, especially postoperative ones, doctors advise getting out of bed on the second day after surgery. This heartless recommendation is explained by the fact that when moving, even slowly, the internal organs of the abdominal cavity undergo a natural massage from the abdominal muscles involved in the walking process. And 5-8 days after the first short walks around the ward, it is advisable to begin performing feasible exercises for the abdomen: bending, turning, etc.

In addition to operations, official medicine also recognizes complex treatment using enzyme therapy. It includes injections of lidase, lyrase, streptase, urokinase, ribonuclease. Injections are combined with rubbing ointments into the abdominal wall, including anti-inflammatory substances and plant enzymes.

But most effective means saliva remains from adhesions. which, after waking up, should be generously lubricated at the sites of adhesions and scars. Human saliva, especially in the morning, before you have eaten or drunk anything, contains a large amount of enzymes that can dissolve adhesive tissue. Essentially, you are using the same enzyme therapy, only in a natural and painless way, and absolutely free!

Massage for postoperative adhesions and scars in the abdominal area.

And of course, we should not forget about therapeutic massage. Its main task is to detect adhesions (possibly with the help of additional examination) and create such tension in this area that the adhesion site is activated. By and large, you can massage any lump, especially one left after surgery, especially if you feel in this place nagging pain. Such places are your battlefield. When doing a massage, you should try to separate the organs, separate them, without forcibly tearing them apart or further injuring them. Your goal is to force the body to solve the problem on its own, although not without help. And although with such a massage you may experience quite painful sensations, you will have to try and be patient. However, under no circumstances should you massage recently injured areas or fresh postoperative wounds.

So let's begin. When massaging with your fingertips, try to create a pulsating sensation in the area of ​​the adhesions. The principle of action is simple, the main thing is to make movements along the natural arrangement of the organs.

Exercise to massage postoperative adhesions.

Lie on your back, bend your knees, and place a cushion under your head for comfort. Right hand place it to the right of the navel and press your thumb into the area above it three fingers. Left hand Place it so that your thumb rests three fingers below the navel. As you exhale, press down on soft fabrics, and then move your fingers towards each other (that is, towards the center of the abdomen) (Fig. 6.29). Hold your breath and perform slow massaging movements with your fingers. As you inhale, return your arms to the starting position. Repeat 5-6 times. Perform the exercise every 2 days for 1.5-2 months. Be sure to take weekly breaks after 10 exercises in a row.

This massage increases blood circulation, promotes the resorption of adhesions, softens tissues and restores organ mobility.

Therapeutic massage has no contraindications. It can be used for pain in the joints, spine, muscles, to normalize blood circulation and the functioning of internal organs.

Causes of adhesions

What are adhesions?

Spikes- these are compactions of connective tissue that appear after inflammation or surgical interventions and extend from one organ to another. Adhesions may occur after surgery.

If adhesions occur in the pelvic area or abdominal cavity, then the woman may not conceive. Therefore, you should periodically consult a gynecologist to identify the cause of infertility. Adhesions are also formed due to periodic inflammation of the appendages or after sexually transmitted infectious diseases.

Reasons for the formation of adhesions

The cause of adhesions in the pelvis can be endometriosis, surgery, an inflammatory disease, or blood in the abdominal cavity.

Another cause of adhesions can be inflammation - for example, inflammation of appendicitis, damage to the colon and small intestine. Then adhesions will form in places fallopian tubes, ovary, uterus. In this case, the genitals will not be damaged.

But if the adhesive process also affects the genitals, then they will also be damaged. Mainly the fallopian tube may be damaged, and then conception and pregnancy will be impossible. When an infection enters the fallopian tubes, an inflammatory process occurs, and then adhesions form. This is possible after an abortion.

If you see a doctor too late, then after treating the adhesions, the fallopian tube will no longer be able to promote the fertilized egg. Then fertilization will become almost impossible even artificially. Sometimes, after an illness, to enable a woman to become pregnant, IVF is done and the fallopian tube has to be removed completely. After inflammation, the walls of the fallopian tube can stick together and grow together, which means that the egg will not be able to pass through and the adhesions and the tube will need to be removed.

Postoperative adhesions

Adhesions can form after surgery if tissue hypoxia or ischemia occurs, rough manipulation of the tissue occurs, tissue drying during surgery, the presence of blood, separation of previously adhesions, or the presence of foreign bodies.

Foreign bodies may remain after surgery - for example, when particles of talc from the surgeon’s gloves or fibers from tampons or gauze enter the body cavity. Adhesions can also occur with endometriosis. This is the passage of some menstrual blood into the abdominal cavity through the fallopian tubes. If a woman has a good immune system, then the cells of the uterine mucosa that are in the menstrual blood are removed on their own. And if the immune system is impaired, adhesions can form.

Treatment

Using special instruments, dissection and removal of adhesions are performed. This can be done with laser therapy, electrosurgery and aquadissection.

Spikes

Postoperative adhesions

The golden mustache is successfully used in treatment during the postoperative period, due to which the patient’s well-being improves, sutures heal faster, the postoperative recovery period is reduced and performance increases.

For treatment in the postoperative period, alcohol tincture of callisia is used. To prepare the drug, 25-30 joints of the plant are crushed, poured with 0.25 liters of vodka, infused for 14 days, then filtered.

The tincture is used according to the following scheme:

On the first day, 10 drops of tincture are mixed with 1.5 tablespoons of water and drunk in the morning 45 minutes before meals.

After the dose per dose is 33 drops, begin to decrease by 1 drop per day.

When the amount of the drug taken again reaches 10 drops, take a break for 7 days, after which the course is repeated in the same sequence.

To treat postoperative adhesions, it is necessary to undergo 4-5 courses, taking 7-day breaks after the first and second and 10-day breaks after all subsequent ones.

Adhesive disease (adhesions). Treatment of adhesions

Adhesive disease (morbus adhaesivus) is a term used to refer to conditions associated with the formation of adhesions (connective tissue cords) in the abdominal cavity in a number of diseases (usually inflammatory in nature), after traumatic injuries and surgical interventions.

Adhesive disease began to be often mentioned in the literature from the late 19th and early 20th centuries in connection with the development of abdominal surgery. Most common cause adhesive diseases are inflammation of the appendix (appendix) and appendectomy (about 43%), in second place are diseases and operations on the pelvic organs and operations for intestinal obstruction (about 30%).

General information about adhesive disease

The organs of the abdominal cavity and small pelvis (uterus, fallopian tubes, ovaries, bladder, rectum) are externally covered with a thin shiny membrane - the peritoneum. The smoothness of the peritoneum, combined with a small amount of fluid in the abdominal cavity, ensures good displacement of intestinal loops, uterus, and fallopian tubes. Therefore, normally, the work of the intestines does not interfere with the capture of the egg by the fallopian tube, and the growth of the uterus during pregnancy does not interfere with the normal work of the intestines and bladder.

Inflammation of the peritoneum - peritonitis - is a very dangerous disease. And the more dangerous it is, the more space it occupies in the abdominal cavity or small pelvis. But there is a mechanism in the body that limits the spread of peritonitis - the formation of adhesions.

With the development of the inflammatory process in the pelvis, the tissues at the site of inflammation become swollen, and the surface of the peritoneum is covered with a sticky coating containing fibrin (the protein that forms the basis of the blood clot). The fibrin film on the surface of the peritoneum at the site of inflammation glues adjacent surfaces to each other, resulting in a mechanical obstacle to the spread of the inflammatory process. After the end of the acute inflammatory process, adhesions in the form of transparent whitish films can form in places where internal organs stick together. These adhesions are called adhesions. The function of adhesions is to protect the body from the spread of a purulent-inflammatory process throughout the abdominal cavity.

The inflammatory process in the abdominal cavity does not always lead to the formation of adhesions. If treatment is started on time and carried out correctly, the likelihood of formation of adhesions is reduced. Adhesions form when an acute process becomes chronic and the healing process extends over time.

Adhesions can interfere with the normal functioning of internal organs. Impaired mobility of intestinal loops can lead to intestinal obstruction. Adhesions affecting the fallopian tubes, uterus, and ovaries disrupt the entry of the egg into the fallopian tube, the movement of sperm along the fallopian tube, the meeting of sperm and egg, and the advancement of the embryo after conception to the place of attachment in the uterine cavity. In gynecology, adhesions can cause infertility and pelvic pain.

Symptoms of adhesive disease

The scale of the adhesive process in the abdominal cavity can be different: from total spread over the entire surface of the peritoneum to the formation of separate cords (strangs) fixed at 2 points and causing compression of the intestinal loops.

The acute form is manifested by a sudden or gradual development of pain, increased intestinal motility, vomiting, and a rise in temperature. The pain may become progressive.

A blood test reveals leukocytosis and accelerated ESR.

As intestinal obstruction increases, vomiting occurs small intestine, symptoms of peritoneal irritation and tachycardia appear. With a further increase in the phenomena of obstruction, intestinal bloating and lack of peristalsis are observed. daily diuresis decreases. arterial hypotension develops. cyanosis is observed. acrocyanosis. thirst, drowsiness, prostration, hypoproteinemia. disturbance of water metabolism - first extracellular and then intracellular dehydration. Violated mineral metabolism. The level of potassium and sodium in the blood sharply decreases, which is manifested clinically by general weakness, hypotension, weakening or disappearance of reflexes. Disorders of protein and water-salt metabolism determine the severity of the patient's condition and the depth of intoxication.

In the intermittent form of adhesive disease, painful attacks appear periodically, the intensity of pain varies, dyspeptic disorders, symptoms of discomfort, and constipation occur. Patients with this form of adhesive disease are repeatedly hospitalized in surgical departments.

The chronic form of adhesive disease is manifested by aching abdominal pain, a feeling of discomfort, constipation, loss of body weight and periodic attacks of acute intestinal obstruction.

Causes of adhesive disease

The most common cause of adhesions is inflammatory diseases pelvic organs. Why? Let's figure it out together.

Inflammatory diseases of the genital organs occur in 60-65% of all gynecological patients. A significant proportion is caused by inflammation of the fallopian tubes and ovaries.

When an infection enters the fallopian tubes, inflammatory exudate does not always form. Abortion of acute inflammation of the mucous membrane of the tubes may occur before it enters the exudation stage. In many patients, the exudate formed in the acute stage of the disease resolves. Only in a small proportion of patients, an acute inflammatory process in the fallopian tubes leads to the spread of inflammatory serous or purulent exudate throughout the tube. Exudate flowing through the abdominal opening of the tube into the abdominal cavity can cause a response - loss of fibrin, sealing the abdominal opening, which is hermetically obliterated over time. The fallopian tube turns into a closed cavity. During development purulent process a pyosalpinx is formed in it. If the uterine opening of the tube remains open, exudate may leak into the uterine cavity and then through the vagina to the outside. From the fallopian tubes with exudate and hematogenously, bacteria can penetrate the ovary and cause its purulent melting (pyovar).

Both the fallopian tube and the ovary increase in size as the inflammatory exudate accumulates, with the tube acquiring a retort-shaped shape and the ovary a spherical shape. In the mucous membrane of the tube, areas of desquamation of the epithelium and gluing of opposite surfaces with the formation of partitions are observed. As a result, a multi-chamber saccular formation is formed, filled in some cases with serous exudate - hydrosalpinx, in others - with purulent exudate - pyosalpinx. When gluing and then fusion of the pyosalpinx and pyovar at the fusion sites, melting of the capsules may occur.

The tunica albuginea of ​​the ovary and the wall of the fallopian tube as it is deposited in them hyaluronic acid and the proliferation of fibrous tissue turns into dense, impenetrable capsules. These inflammatory formations (hydrosalpinx, pyosalpinx, pyovar, purulent tubo-ovarian tumors) are usually fused with the walls of the pelvis, with the uterus, fallopian tube, ovary of the opposite side, with the omentum, bladder and intestines. The formation of capsules impenetrable to microbes and extensive adhesions in the acute stage plays a protective role, preventing the spread of infection. Subsequently, after the death of the causative agents of the inflammatory process, these impenetrable capsules delay the resorption of the accumulated serous or purulent exudate.

The location of the pelvic organs with inflammatory saccular formations changes significantly, and the function of neighboring organs (rectum, bladder) and, of course, reproductive function are often disrupted.

Mechanical (traumatic) damage to the peritoneum or serous membrane or exposure to certain chemicals(iodine, alcohol, antibiotics, sulfa drugs, talc, etc.) also contribute to intensive formation of adhesions.

Adhesions develop when there is hemorrhage in the abdominal cavity, especially when the escaping blood becomes infected. In gynecology, the formation of adhesions is often caused by bleeding during ectopic pregnancy and ovarian apoplexy. The importance of peritoneal trauma, cooling or overheating in the development of adhesive disease has been experimentally proven.

The presence of foreign bodies (wipes, drains) in the abdominal cavity during surgery is also accompanied by the formation of adhesions.

Rarely, adhesive disease develops as a result of congenital anomalies such as planar adhesions between intestinal loops (Lane's cords) or adhesions between parts of the colon (Jackson's membrane).

In some cases, the formation of adhesions takes on a progressive course, the causes of which are not fully established, but the significance of the extent of the inflammatory process and the virulence of the microbial flora is beyond doubt. In these cases, intestinal deformities occur, normal motility and evacuation of intestinal contents are disrupted.

Diagnosis of adhesive disease in gynecology

The presence of adhesions in the abdominal cavity can be suspected in patients who have previously undergone pelvic inflammatory diseases, surgical operations on the pelvic and abdominal organs, and in women suffering from endometriosis. However, only in half of the patients with more than two risk factors for the development of adhesions in the anamnesis, adhesions are detected during laparoscopy (an operation during which small holes are made in the anterior abdominal wall through which an optical device is inserted to examine the cavity and special surgical instruments).

A gynecological examination suggests the presence of adhesions in the abdominal cavity with a probability of 75%.

Obstruction of the fallopian tubes according to hysterosalpingography (a contrast agent is injected into the uterus, X-rays are taken) and ultrasound examination with a high degree of certainty indicates the presence of an adhesive process, however, the patency of the fallopian tubes does not exclude the presence of adhesions that seriously impede pregnancy.

Conventional ultrasound does not reliably detect the presence of pelvic adhesions.

Today, the nuclear magnetic resonance method seems to be very promising in diagnosing the adhesive process. Using this method, images are obtained that reflect the “state of affairs” at different levels.

The main method for diagnosing adhesions is the laparoscopy method. It allows not only to detect the presence of adhesions and assess the severity of the adhesive process, but also to carry out treatment.

There are three stages of the adhesive process according to laparoscopy:

Stage I: adhesions are located around the fallopian tube, ovary or other area, but do not interfere with the capture of the egg;

Stage II: adhesions are located between the fallopian tube and the ovary or between these organs and other structures and can interfere with the capture of the egg;

Stage III: either torsion of the fallopian tube occurs, or it is blocked by adhesions, or a complete blockade of egg capture.

Treatment of adhesive disease

Treatment, depending on the indications, can be conservative or surgical.

Indications for surgery may occur during an acute attack of adhesive intestinal obstruction (emergency or urgent surgery) or during a recurrent course of adhesive disease (planned surgery). In emergency surgery, adhesions are dissected and the necrotic section of the intestine is resected. In the chronic form of adhesive disease, Noble's operation or its modifications are performed.

It is almost impossible to predict the course of adhesive disease. With frequent relapses of adhesive disease, patients lose their ability to work. The prognosis is more favorable for single adhesions.

In gynecology, the main method of treating adhesions is laparoscopy. Using special micromanipulators, adhesiolysis is performed - cutting and removing adhesions. Adgeolysis is carried out using the following methods:

– laser therapy – dissection of adhesions using a laser);

– aquadissection – dissection of adhesions using water supplied under pressure;

– electrosurgeon – dissection of adhesions using an electric knife.

During laparoscopy, the following methods are used to prevent the formation of new postoperative adhesions:

introduction into the spaces between anatomical structures of various barrier liquids (dextran, povidin, mineral oils, etc.);

wrapping the fallopian tubes and ovaries with special polymer absorbable films.

Spikes. Treatment folk remedies. Symptoms of manifestation various types adhesions

Many people have heard about such a disease as adhesions. but not everyone has an idea of ​​what it is and why it is formed. Depending on location adhesions can manifest themselves in various clinical manifestations: palpitations, pain, shortness of breath, impaired passage of food, etc. In this article we will tell you what adhesions are, types of adhesions, How treat adhesions with folk remedies .

What are adhesions and how to treat them?

Adhesive disease. or as people say - adhesions– this is a condition that is characterized by the appearance of adhesions in the pelvic and abdominal organs.

Causes of adhesions in the pelvis

– inflammatory diseases. This includes various infectious diseases uterus, uterine appendages and pelvic peritoneum (endometritis, parometritis, salpingoophoritis, pelvioperitonitis);

– long-term wearing of an intrauterine device;

– curettage of the uterine cavity (abortion);

– STIs (sexually transmitted infections);

– inflammatory diseases of the peritoneal organs (appendicitis);

– any mechanical damage to one or more elements of the pelvis and peritoneum;

– any hemorrhage into the abdominal cavity. This may be a consequence of rupture of the fallopian tube due to ectopic pregnancy, ovarian apoplexy, etc.;

– endometriosis is a disease that is characterized by the growth of endometrioid tissue beyond the endometrium (inner layer of the uterus);

– surgery;

Symptoms of pelvic adhesions

Adhesions can manifest themselves in different ways, depending on the form of the disease:

Acute form

Patients with this form of the disease note pronounced painful sensations. They are worried about nausea, vomiting, sometimes body temperature rises, and the heart rate also increases. When pressing on the abdomen, sharp pain is noted; due to the formed adhesions, intestinal obstruction occurs, which is characterized by a sharp drop in pressure, a decrease in the amount of urine excreted, patients note weakness and drowsiness. The condition of such patients (with an acute form of adhesions) is usually assessed as severe.

Intermittent form

This form of the disease is characterized by periodic pain, and patients may also complain of constipation or diarrhea.

Chronic form of adhesions

The chronic form is characterized by a latent course. There is no clinical manifestation as such, but rare cases may occur. aching pain in the lower abdomen.

The chronic form of adhesions is most common in gynecology. The course of the hidden adhesive process causes obstruction of the fallopian tubes ( fallopian tube adhesions), which leads to infertility.

Intestinal adhesions

Intestinal adhesions or adhesive disease of the abdominal cavity characterized by the “fusion” of organs with each other (intestine-intestine, omentum-intestine). Such adhesive disease manifests itself depending on the dysfunction of organs that have “fused together”:

1) asymptomatic manifestation of intestinal adhesions;

2) painful form intestinal adhesions. There is abdominal pain, most often in the area of ​​postoperative scars (postoperative adhesions);

3) painful form intestinal adhesions with dysfunction of internal organs. This form can manifest itself as diarrhea, constipation, a feeling of fullness after eating, bloating, etc.;

4) spicy adhesive intestine I have obstruction.

Treatment of adhesions

There are several ways treatment of adhesions. These are conservative surgical methods. But it should be remembered that early stages treat adhesions Can folk remedies .

Take two tablespoons flaxseed and wrap them in gauze. Immerse the bag in boiling water for three minutes, then cool, squeeze out the water, and distribute the gauze bag with the seed over the sore spot. Keep it this way throughout the night.

Bergenia for the treatment of adhesions

For treatment of adhesions this folk remedy it is necessary to prepare an infusion. This is done like this: take 60 grams bergenia root(chopped) and pour hot water(60 degrees) in the amount of 350 grams. Then the decoction must be infused for 8 hours. After the infusion has infused, it should be placed in the refrigerator. The infusion is used for douching, which is carried out in the morning and evening (for douching, dilute two tablespoons of bergenia infusion per liter of boiled water).

St. John's wort for the prevention and treatment of adhesions

It is very useful to use herbal remedies during the rehabilitation period as an addition to the main treatment. For such purposes it is better to use St. John's wort. dried and crushed. To prepare the decoction, take a tablespoon of St. John's wort and pour one glass of boiling water. The broth should be boiled for 15 minutes, then cooled and strained. Accept this remedy¼ of a glass three times a day.

To prevent adhesions It is necessary to regularly see a gynecologist, perform gynecological massage, treat urogenital infections in a timely manner, refuse abortions, give birth only through the natural birth canal, and have a regular sex life.

Adhesions are ropes of connective tissue formed as a result of surgical interventions or all kinds of inflammation, stretching from organ to organ. Sometimes there are cases where adhesions form in the abdominal cavity and pelvis; such adhesions can block the path to conception, therefore it is necessary to constantly be examined, and if they are found, they must be eliminated.

Adhesions after surgery - what is it?

The organs of the pelvis and abdominal cavity (fallopian tubes, the uterus itself, bladder, ovaries, rectum) are usually covered on the outside with a thin, bright membrane - the peritoneum. A small amount of fluid and the smoothness of the peritoneum ensures fairly good displacement of the uterine loops and fallopian tubes. In normal bowel function, there are no problems with the capture of the fallopian tube by the egg, and the growth of the uterus does not interfere with the good functioning of the bladder and intestines.

Peritonitis - inflammation of the peritoneum is a very dangerous disease. The more inflammation the the disease is more dangerous. The body has a mechanism that limits the spread of this disease, this is the formation of adhesions.

During the inflammatory process, tissues become swollen, the peritoneum becomes covered with a sticky coating that contains fibrin - this is the protein that forms the basis of a blood clot. Touching this thin film of fibrin at the site of inflammation, we can say that it glues the surfaces to each other, the result of this action is a mechanical obstacle to the inflammatory process. After the inflammatory process has ended, adhesions (transparent - whitish) films can form in the places of gluing. They are called spikes. The main function of adhesions is to protect the body from pus and inflammation in the peritoneum.

But we would like to note that during the inflammatory process, adhesions do not always form. If treatment began on time and all procedures were carried out correctly, the likelihood that adhesions will form in the body decreases. But still, adhesions form when the disease becomes a chronic process and drags on over time.

These adhesions after completion of gynecological surgery interfere with the normal functioning of internal organs. If the mobility of the intestinal loops is impaired, this can lead to intestinal obstruction. Adhesions that affect the fallopian tubes, ovaries, and uterus disrupt the functioning of the body (the egg enters the fallopian tube, movement, and advancement of the embryo into the uterine cavity). Adhesions can be a major cause of infertility.

• All kinds of inflammatory diseases;
• Operations;
• Endometriosis;
• Thickened blood in the peritoneum.

Adhesions due to inflammation

The ovaries, uterus and fallopian tubes may be involved in adhesions, which can result from inflammation of the organs (eg appendicitis), in some cases damage to the large and small intestines. In such cases, the genitals are not severely damaged - the process of formation of adhesions does not disturb the internal structure. When inflammation occurs in the genitals, a process of formation of adhesions occurs that disrupts the functioning of the genitals.

The most unprotected is the fallopian tube, which is the most delicate organ. Plays a major role in conception and maintenance of pregnancy.

Sperm that penetrate the vagina are, in turn, filtered through the mucus of the cervix, pass first into the uterine cavity, and then penetrate the fallopian tube. Speaking about the fallopian tube, we can say that it ensures the transportation of the embryo and germ cells, and creates an environment for the development of the embryo. A change in the composition of the mucus that appears in the fallopian tube can destroy the embryo. Immunity in the fallopian tube is minimal; there are practically no mechanisms there that would reject foreign substances; excessive immune activity is unfavorable for pregnancy. The fallopian tubes are very delicate and easily become victims of infections (diagnostic curettage, abortion, hysteroscopy).

The infection from the very beginning affects the mucous membrane, then the muscle layer, at the last stage the outer layer of the fallopian tube is involved and conditions arise for the occurrence of so-called intestinal adhesions. If treatment of these adhesions is not carried out in a timely manner, scar tissue forms. The fallopian tube turns into a connecting sac and loses its ability to promote the egg. With such severe disorders, elimination of adhesions does not restore the function of the fallopian tube; the presence of this focus of inflammation leads to infertility. In these cases, for pregnancy, the entire tube is removed.

Postoperative intestinal adhesions

After the operation has been performed, adhesions are formed in the following cases:

• Tissue ischemia or hypoxia;
• Drying fabrics;
• Rough handling of fabric;
• Foreign bodies;
• Blood;
• Separation of early adhesions.

To those foreign bodies that cause the formation of adhesions include particles from doctor’s gloves, cotton fibers from tampons and gauze, and suture material. Intestinal adhesions after gynecological surgery are a dangerous problem; such adhesions can also appear with endometritis. During menstrual cycle blood containing living cells of the membrane (endometrium) can enter the abdominal cavity. Immune system should itself remove these cells, but if there are disruptions in the immune system, the cells take root and form endometrial islands, and adhesions usually form around these foci.

Treatment of adhesions

Only under the visual control of an experienced surgeon should tumor isolation and separation of adhesions be carried out. The intestine is pulled back and upward with the finger of the surgeon's assistant or by the anatomical patient. If the tumor is located behind the abdomen, then in this case the peritoneum is dissected where there is no intestine above the upper pole of the tumor, and then the tumor is carefully and slowly isolated. To avoid damaging the intestine in any way, professional surgeons leave capsules or part benign tumor on the intestinal wall with dense adhesions. In some cases, it will even be better if you first cut the fibroid capsule in an accessible place, then enucleate it, and then carefully separate the intestine from the capsule or excise the capsule as carefully as possible without damaging the rectum.

However, despite all efforts, often after extensive surgical interventions the process of adhesions continues to develop. This is largely determined by the characteristics of the human body and the nature of the intervention. However, even after the appearance of adhesions, the intestines can be treated, reducing the symptoms of the disease.

Causes

Adhesive disease is a condition that occurs when a large number of individual adhesions are formed or a significantly pronounced adhesive process is formed, which leads to disruption of the functioning of internal organs.

In most cases, intestinal adhesions occur after surgery. Most often they appear after major operations performed by laparotomy (through a large incision in the abdominal wall).

Doctors who operated at the dawn of surgery noticed that when repeated operations were necessary, adhesions between individual organs were found in the abdominal cavity. Even then, it was clear to surgeons that numerous complaints presented by patients after surgical interventions on the abdominal organs were associated with adhesions. Since then, the complex history of studying this problem began.

The adhesive process is currently one of the most studied pathological processes in the human body. The main reactions of the internal environment that play a decisive role in the occurrence of adhesions include:

• inflammatory tissue reaction;
• coagulation of blood and the proteins it contains;
• anti-coagulation.

During surgery, trauma to the peritoneum is inevitable. In the event that only one of its leaves was damaged, and the one with which it is in contact remained intact, adhesions will not form. But even if such an injury causes a fusion between organs, it will be superficial, easily stratified and will not lead to dysfunction of the organs.

If 2 adjacent leaves were injured, then a whole cascade of pathological reactions is triggered. Due to a violation of the integrity of the blood capillaries, the release of individual blood proteins occurs. Globulins (namely coagulation factors) play a major role in the adhesion of organs. When these proteins come into contact with exposed intestinal tissue, a cascade of clotting reactions is triggered. The outcome of this cascade is the precipitation of fibrinogen in the form of fibrin. This substance is the universal “glue” of our body, which leads to the formation of early intestinal adhesions.

In the process of blood clotting, the anticoagulation system plays a significant role, which is activated somewhat later than the coagulation system. In most cases, blood that gets onto the peritoneum of the intestinal loops first coagulates and then returns to the liquid phase precisely thanks to the fibrinolysis system (dissolution of precipitated fibrin). But sometimes, upon contact with the peritoneum, this process can be disrupted, and fibrin does not dissolve. In this case, polar cods may appear.

How does the disease manifest itself?

In most cases, the resulting adhesions are small in size and do not actually affect the functioning of the internal organs. However, when deformation of the structure occurs, symptoms of adhesions occur. The clinic depends on both the size and localization of the pathological process. To the most frequent symptoms adhesive process include:

• abdominal pain;
• feeling of discomfort in the abdomen;
• constipation;
• general weakness;
• mental disorders.

Pain in the abdomen is the main manifestation of adhesive disease. The cause of the pain is a serious disruption of the functioning of the intestines. The nature of the pain may also differ from patient to patient. For some it is permanent, for others it is cramping. A feature of pain receptors in the intestinal wall is their increased sensitivity to stretching. Therefore, physiological bowel movements (peristalsis) can lead to significant intestinal tension and provoke pain.

This is also the cause of pain after eating certain foods, which contribute to increased gas formation or increased peristaltic movements of the intestine. Separately, it is worth mentioning the pain, which intensifies with physical activity.

More often it occurs when the adhesion is located between the loops of the intestine and the anterior abdominal wall. Due to the contraction of the abdominal muscles, tension occurs in the intestinal tissue and its mesentery. With excessive physical exertion, this can lead to the formation of obstruction. The appearance of discomfort is due to approximately the same reasons as pain.

Diagnosis of adhesions is based on the collection of numerous complaints. Some patients may experience no pain or discomfort at all. But constant constipation and the presence of major abdominal surgery in the past should suggest an adhesive process. Abnormal bowel movements occur due to chronic damage to the intestinal wall and decreased motor activity. The consequence of such changes is a slowdown in the movement of chyme along the intestinal tube. The process of final formation is subsequently delayed feces and a decrease in the frequency of fecal excretion.

General manifestations of the disease

Intestinal adhesions manifest themselves as symptoms - both local and general. These include constant weakness, row mental disorders and decreased immunity. There are several reasons for these manifestations:

1. Constant pain and discomfort in the abdomen leads to exhaustion nervous system and form the so-called “core” of psychological changes in consciousness.
2. Disruption of normal intestinal motility leads to a decrease in the flow of nutrients into the bloodstream.
3. Prolonged presence of feces in the large intestine promotes increased proliferation of microorganisms in its lumen.

The occurrence of pain both during movements, physical activity, and at rest contributes to the formation of protective behavior. It manifests itself in the fact that the patient tries to avoid a certain movement, posture or behavior. Accordingly, the normal spectrum of activity is limited. This may affect the sphere of professional activity, which ultimately leads to some withdrawal from social contacts.

In addition, the belief is formed in the mind that this condition was caused by the actions of medical personnel, so in the future you should avoid seeking medical help. medical care. All this together leads to a delay in proper care and worsening of the condition.

Intestinal adhesions, disrupting intestinal motility and reducing the absorption of nutrients, are mainly associated with a violation of a person’s nutritional status. Arises chronic failure proteins, fats and carbohydrates. The result is weight loss and reduction immune status. However, this is not typical for all individuals who have developed adhesions as a result of surgery. The addition of vitamin deficiencies significantly complicates the course of the underlying disease and can contribute to the addition of secondary bacterial complications.

Complications of the disease

In addition to nutritional disorders, vitamin deficiencies and mental disorders that develop over years, the course of the adhesive process may be complicated by severe and often life-threatening conditions:

• acute intestinal obstruction.
• intestinal necrosis.

Acute intestinal obstruction develops when adhesions deform the intestine so much that its patency virtually completely disappears. In this case, acute cramping pain in the abdomen occurs. Quite clear localization of pain at the site of obstruction is possible. This pain is easy to distinguish from the usual course of the disease, which is associated with its severity and suddenness, and not with any movement or position of the body.

Vomiting follows very quickly. At first, the vomit has signs of previously eaten food, but after a while bile impurities appear. And if left untreated, the vomit becomes fecal (since the intestinal contents can no longer move in a physiological direction). Occasionally, blood appears in the stool. Common manifestations include the following:

• in the first place is pronounced general weakness;
• body temperature rises;
• the patient’s facial features become sharper;
• the skin takes on a gray tint;
• eyes are sunken;
• in the absence of emergency surgical care, death occurs within a few days.

An equally serious complication is necrosis of a section of the intestine. In the pathogenesis of this condition, tissue compression of the adhesions is noted. blood vessels and disruption of blood flow in the intestinal area with the development of ischemia ( oxygen starvation), and subsequently - tissue death.

The main manifestation is increased abdominal pain and severe bloating. Vomiting may occur. The temperature rises significantly and chills appear. Due to disruption of the intestinal barrier functions, microorganisms gain access to the systemic bloodstream. As a result, sepsis develops, which requires urgent medical interventions. Otherwise, death will occur within a few hours or days.

Treatment methods

Treatment of adhesions after surgery is a serious, lengthy and controversial issue. The appearance of complications is an absolute indication for surgical treatment. At the moment, numerous techniques are used for this purpose: starting from the intersection of individual elements of adhesive tissue (in the absence of necrosis in the intestinal wall) and ending with excision of a section of the intestine that has undergone necrotic changes.

If the issue of surgical treatment of intestinal adhesive disease has been decided, then full and comprehensive preparation of the patient for surgical intervention is necessary, aimed at correcting the disturbed parts of metabolism and compensating for all concomitant diseases. The surgeon's goal is to remove as much of the connective tissue that forms the adhesions as possible. However, this procedure is only temporary, because even after removing adhesions, areas of tissue remain that can later “stick together” again, and the symptoms of adhesive disease return.

There are many controversial opinions on how to treat adhesions formed after surgery conservatively (without surgery). However, all experts agree that a radical cure is possible only by removing the adhesions themselves. The attending physician can suggest a number of techniques that, as a rule, will alleviate the patient’s condition, but will not get rid of the cause. These include:

• dietary food;
• periodic forced bowel cleansing;
• symptomatic drug treatment.

The peculiarity of nutrition is to eat food throughout the day in small portions, but often. It is necessary to avoid foods that increase the formation of gases (legumes, foods containing significant amounts of fiber).

Forced bowel cleansing means performing cleansing enemas. This procedure should be carried out as needed, but not more than 3 times a week. Drugs that can reduce the manifestations of the disease include antispasmodics (No-spa and its analogs), painkillers (Ketanov, Fanigan).

Disease prevention

Most patients are interested in how to avoid adhesions. Recommendations in this regard concern both the doctor and the patient. It is up to the patient to seek medical help in a timely manner in order to prevent the development of complications that significantly aggravate the course of surgical pathology. In some cases, timely prescribed conservative treatment may have sufficient effect and surgical intervention will not be required.

If, nevertheless, it is not possible to refuse the operation, then the prevention of the development of adhesions largely depends on the surgeon. However, it is worth noting that even the most modern methods surgical treatment and the best techniques do not give an absolute guarantee. The likelihood of adhesion formation is reduced if minimally invasive interventions are performed, and all actions are carried out with the utmost care. Even if a section of the intestine has to be removed, all measures must be taken to prevent the development of adhesions. Thus, the prevention of adhesions depends on both the doctor and the patient.

Possible causes, dangers, types of diagnosis and treatment of postoperative adhesions

Postoperative adhesions are dense connective tissue formations in the abdominal or pelvic cavity that connect internal organs. They are formed at the site of damage, inflammation and represent a kind of protective reaction of the body - an attempt to limit the source of the disease. Adhesions disrupt the normal functioning of the abdominal organs and lead to serious complications.

Why do adhesions form?

Connective tissue cords (adhesions) in the abdominal or pelvic cavity are formed as a consequence of surgical interventions or as a response to inflammatory processes in this area. The body grows additional tissue, secretes sticky fibrin and glues nearby surfaces together in an attempt to support the diseased organ or stop the spread of inflammation. Adhesions can take the form of scars, threads or films connecting adjacent organs and intestinal loops.

Reasons for the formation of adhesive cords:

• tissue damage as a result of surgical interventions (laparoscopy, laparotomy);
• inflammation of the appendix and surgery to remove it (appendectomy), diverticulitis;
• abortion, uterine curettage, caesarean section;
• long-term use of intrauterine contraceptives;
• hemorrhage into the body cavity;
• endometriosis;
• inflammatory diseases of the abdominal and pelvic cavities, including sexually transmitted diseases.

Postoperative adhesive disease is caused by tissue damage, hypoxia, ischemia or drying, as well as entry into the body cavity foreign objects, some chemicals (talc particles, gauze fibers).

Why are adhesions dangerous?

Normally, the organs of the abdominal cavity and pelvic cavity are mobile. Intestinal loops can shift during digestion, but their movements do not interfere with the transport of the ovulated egg into the fallopian tube, and the uterus, which increases during pregnancy, does not have a critical effect on the bladder.

The resulting scars, limiting inflammation, interfere with the normal mobility of organs and the performance of their functions. Adhesions can provoke acute intestinal obstruction or the development of female infertility. In some cases, the formation of adhesions does not cause a person discomfort or unpleasant sensations, but most often adhesive disease is accompanied by severe pain.

Symptoms of pathology

The manifestation of the disease depends on the degree of its development. There may be individual adhesive strands fixed at two points, or a large number of adhesions over the entire surface of the peritoneal membrane.

Acute form

Pathology often manifests itself in acute form, with sudden onset of pronounced symptoms, such as:

• acute, intensifying abdominal pain;
• intestinal obstruction;
• vomit;
• active intestinal motility;
• febrile temperature;
• tachycardia.

As intestinal obstruction progresses, the symptoms intensify:

• there is bloating of the intestine;
• peristalsis stops;
• diuresis decreases;
• arterial hypotension occurs;
• there is a violation of the exchange of fluid and microelements;
• getting worse general condition, weakness and weakening of reflexes appear;
• severe intoxication occurs.

Intermittent form

Symptoms are less pronounced and appear periodically:

• pain of varying intensity;
• digestive disorders, constipation, diarrhea.

Chronic form

The adhesive process in its chronic form is hidden and can manifest itself as rare nagging pain in the lower abdomen, digestive disorders, and causeless weight loss. Often, adhesions are the hidden cause of female infertility.

Diagnosis of adhesive disease

The presence of adhesions can be assumed if the patient has suffered in the past surgical interventions on the abdominal or pelvic organs, infectious and inflammatory diseases of the genitourinary system, endometriosis.

These risk factors contribute to the formation of adhesions, but are not a 100% guarantee of their presence. To confirm the diagnosis, it is necessary to conduct a series of studies.

1. Certain diagnostic data are obtained from examination in a gynecological chair.
2. X-ray examination of the uterus with the introduction of a contrast agent determines obstruction of the fallopian tubes, which is often caused by adhesions. However, if patency of the oviducts is established, adhesions cannot be excluded.
3. Ultrasound results cannot determine the presence of adhesions in the abdominal cavity.
4. Magnetic resonance imaging provides high accuracy of results.

The main method for diagnosing adhesive disease remains laparoscopy. With the help of special instruments inserted into the patient’s abdominal cavity during laparoscopy, the doctor can assess the degree of development of the pathology and, if necessary, immediately perform therapeutic manipulations.

Treatment of postoperative adhesions

If adhesions are just beginning to form at the site of the inflammatory process, there is a possibility of their spontaneous resorption, provided that they are treated quickly and adequately. Over time, thin films of adhesions harden, thicken and become more like scars and cicatrices.

Operation

The main treatment method for acute and advanced chronic forms of the disease is surgical removal of adhesions. The patient receives general anesthesia, and the surgeon uses special instruments to detect, dissect and remove adhesions.

1. To access the abdominal cavity, laparotomy (an incision in the abdominal wall) and laparoscopic methods (access through punctures) can be used.
2. Excision of adhesions is carried out using a laser, electric knife or water supplied under strong pressure (aquadissection).

The operation provides one-time removal of pathological formations, but does not guarantee protection against relapses. The more surgical interventions the body undergoes, the more likely the development of adhesions is. Therefore, special methods are often used to prevent pathologies after medical surgery: the introduction of barrier liquids (mineral oil, dextran), wrapping organs in a self-absorbable film.

Enzymes

Enzyme therapy, including injections of digestive enzymes (lipase, ribonuclease, lidase, streptase) and rubbing anti-inflammatory ointments into the abdomen, can have a good effect.

One of the most powerful enzyme agents is human saliva. The substances contained in it are capable of dissolving adhesive tissue. Saliva is especially active in the morning, when a person has not yet eaten or drunk. It is recommended to apply it liberally to scars.

Therapeutic massage

During a manual examination of the abdomen, adhesions are detected as compacted areas. Sometimes pressure on them causes nagging pain. The massage is designed to create tension in the affected area, activate abdominal tissue, increase blood circulation, and separate organs connected by adhesions.

You need to massage gently, with your fingertips, following the natural location of the internal organs. Massage should not be performed immediately after surgery while the stitches have not yet healed.

Prevention of postoperative adhesions

The main means of preventing the formation of adhesions after surgery is, oddly enough, physical activity. The patient should be out of bed and walking the very next day after surgery. Any, even slow, movement promotes natural massage of internal organs, which prevents the formation of scars and adhesive films.

As early as possible (considering the patient’s condition), it is necessary to begin therapeutic exercises for the abdomen: moderate bends, turns of the body.

A combination of physical activity and special massage can prevent postoperative adhesive disease.

Adhesions after hysterectomy surgery: causes, symptoms and treatment

Adhesions are connective tissue that grows in the abdominal and pelvic cavity. It connects organs and other structures to each other. Adhesions after surgery to remove the uterus appear quite often. Medical statistics indicate that they occur in 90% of cases. This condition is a complication that is dangerous to a woman’s health.

The concept of adhesions

Adhesions are additional tissue, the peculiarity of which is the sticky fibrin it secretes. Because of this, this tissue glues organs together. This is due to the body’s protective reaction, that is, the proliferation of adhesions is necessary to maintain the diseased organ or tissues affected by the inflammatory process.

Connective tissue can look different. Namely, in the form of a film, scar, threads. These tissue forms appear after strip surgery or after minimally invasive interventions.

Reasons for the formation of adhesions after removal of the uterus

The formation of adhesions after removal of the uterus is a common occurrence, since the wound healing process is accompanied by the formation of a connecting scar. The space that has formed begins to be overgrown. The main reason for the occurrence of adhesions is the individual characteristic of the body, in which it does not produce the enzyme responsible for the resorption of fibrin deposits.

The causative factors of this pathological condition are:

• Additional injury to adjacent anatomical structures.
• If during a surgical operation the doctor left instruments, napkins, tampons, etc. in the abdominal cavity.
• Infection during the operation, that is, the use of improperly processed instruments, or violations during dressings in the postoperative period.
• The occurrence of complications after surgery such as internal bleeding.
• Activation of the inflammatory process.

Additionally, the formation of adhesions is influenced by the incision during the operation, namely, the correctness of its execution. The duration of the operation itself is also important.

Pay attention! Medical practice shows that cords after removal of the uterus occur in women who are too thin.

How long does it take for adhesions to form?

Adhesions begin to form from the accumulation of inflammatory fluid or blood that did not resolve after surgery. Moreover, their formation begins already from 7-21 days. The exudate gradually thickens up to this time and begins to be replaced by connective tissue. After 30 days, blood capillaries and nerve fibers are formed in it.

Symptoms and signs

In most cases, the presence of adhesions does not manifest itself in any way. Symptoms appear when the situation becomes more complicated.

The main symptoms include intestinal dysfunction. Namely, intestinal obstruction, which is manifested by pathologically infrequent bowel movements or complete cessation of stool passage. Constipation and flatulence are also observed.

Additionally, there will be the following symptoms:

• general malaise and hypotension;
• pain in the lower abdomen;
• in the future, the patient’s condition is complicated by frequent attacks of nausea and vomiting;
• postoperative suture pain;
• the postoperative suture becomes inflamed - becomes bright red and swollen;
• sometimes there is a fever;
• pain after intercourse.

Diagnostics

Diagnosis of the adhesive process is difficult, since an accurate verdict is possible only after laparoscopy or full abdominal surgery. But a doctor may suspect the presence of adhesions after the following diagnostic methods:

• Laboratory blood tests. With their help, the presence of an inflammatory process is determined and the activity of fibrinolysis can be assessed.
• Ultrasound of the abdominal cavity and pelvis allows you to assess the location of organs. The doctor may assume that there is damage to the connective tissue, since the organs will be incorrectly located.
• Diagnostic laparoscopy is a minimally invasive method that allows, using a special manipulator, to completely visualize organs and other structures.

When adhesions form after surgery to remove the uterus, an X-ray examination of the intestine is sometimes prescribed, especially if there is a complex of symptoms of organ dysfunction. Contrast agents are used for this. As a result, it is clear how narrowed the intestinal lumen is and what degree of intestinal patency.

The danger of adhesions

Adhesions themselves are a postoperative complication. They can cause serious consequences, since the spread of connective tissue contributes to disruption of the normal functioning of organs.

Dangerous complications are:

• acute intestinal obstruction;
• necrotic intestinal lesions;
• peritonitis.

Treatment

When a woman has her uterus removed, she is prescribed preventive therapy. It includes a list medications, which also prevent the formation of adhesions. These include anti-inflammatory drugs, antibiotics and enzyme preparations,

Physiotherapy has also proven its effectiveness. They are used both to prevent the manifestation of adhesions, and even if they are present.

Physiotherapy

Electrophoresis is one of the physical procedures that can destroy postoperative adhesions. It also has a pronounced effect, that is, symptoms are relieved. Procedures are usually prescribed. Electrophoresis is used together with painkillers.

In addition, paraffin and ozokerite applications are used. Today, laser therapy and magnetic therapy are popular treatment methods.

Enzyme preparations

Fibrinolytic agents are very effective in the presence of adhesions, since they contain enzymes that can dissolve fibrin. These include:

• Urokinase - destroys blood clots, dissolving them.
• Fibrinolysis - this substance is capable of dissolving fibrin.
• Chemotrypsin is a means of thinning viscous exudate and thickened blood. Active substance breaks down fibrous deposits and necrotic tissue.
• Hyaluronidase (Lidase) – this drug contains hyaluronic acid. The action is aimed at softening scars, as well as for the treatment of hematomas.
• Streptokinase - this drug is capable of dissolving blood clots, or rather dissolving fibrin in blood clots.
• Trypsin.

Laparoscopy

Laparoscopy is surgical treatment related to minimally invasive interventions. This method involves the doctor making several small incisions through which instruments and a manipulator are inserted. During the operation, adhesions are dissected and blood vessels are cauterized. The doctor must also remove the synechiae. This is done using laser, aquadissection or electrosurgery.

A positive factor of this treatment is the minimal list of complications, which also occur extremely rarely. Also, rehabilitation after laparoscopy does not last long. The very next day after this operation, the woman can get up. Recovery period no longer than a few days.

A strip operation to remove adhesions is called laparotomy.

Prevention

The main prevention of adhesions is proper surgical treatment, without any violations, since adhesions form after operations. Also, the manifestation of cords can be affected by improper rehabilitation methods. How to avoid adhesions? Doctors recommend after surgery to remove the uterus:

• Follow a diet.
• Properly care for the postoperative suture to avoid infection of the wound.
• Avoid excessive physical activity, but at the same time you need to move more.

If all these rules are followed, then the risk of adhesions is reduced.

Conclusion

The adhesive process after surgery is quite dangerous. Therefore, if any symptoms occur, you should consult a doctor. After all, this pathological condition may also lead to dangerous consequences.

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Principles of prevention of adhesive disease in the pelvis

The adhesive process and the formation of adhesions in the abdominal cavity and pelvic organs is a universal protective and adaptive mechanism. It is aimed at delimiting the pathological area, restoring anatomical structure the tissues themselves and their blood supply, disturbed as a result of injury and/or inflammatory process.

Often the formation of adhesions does not lead to pathological changes in the abdominal cavity and goes unnoticed. At the same time, their formation during inflammatory processes in the appendages often leads to infertility, and therefore, for example, the prevention of sexually transmitted diseases, or timely and adequate anti-inflammatory therapy is simultaneously the prevention of adhesions in the fallopian tubes and, accordingly, the prevention infertility.

Reasons for the formation of adhesions after surgery in gynecology and obstetrics

Traditionally, the adhesive process is considered a local tissue disorder that occurs primarily as a result of surgical trauma to the peritoneal surfaces and subsequent inflammatory reactions.

The latter causes a cascade of corresponding processes in the form of exudation (effusion) of the liquid part of the blood, disruption of metabolic processes in tissues, desquamation of the peritoneal epithelial layer of cells, fibrin deposition, formation of elastin and collagen fibers, growth capillary network at the site of damage and formation of adhesions.

A significant role in these processes is played by tissue drying, mesothelial hypoxia when using pneumoperitoneum using carbon dioxide, and surgical manipulation of tissue.

Most often (in 63-98% of all cases) the formation of pathological intra-abdominal and pelvic adhesions (adhesions) between the surfaces of organs and the inner surface of the abdominal wall in the abdominal cavity occurs after abdominal surgery, in particular in the pelvic cavity. They are one of the most important and not fully resolved problems of abdominal surgery, occupying one of the leading places in the structure of postoperative complications.

The presence of adhesions may be asymptomatic. Their clinical symptoms are considered as adhesive disease, manifested by:

• acute or chronic forms of adhesive intestinal obstruction;
• dysfunction of the abdominal and pelvic organs;
• chronic pelvic pain, or abdominal-pelvic pain syndrome;
• menstrual irregularities and tubo-peritoneal infertility (in 40% of cases) in women of reproductive age.

Prevention of adhesions in the pelvis allows you to avoid or significantly reduce the likelihood of developing adhesions. The main causes of adhesions after surgery are damage to the surface epithelial layer (mesothelium) covering internal organs as a result of:

• mechanical impact leading to trauma to the peritoneum at various stages of the surgical operation - dissection of the abdominal cavity, fixation of tissues and stopping bleeding by grasping with clamps and other instruments, excision of individual sections of the peritoneum, wiping and drying with dry gauze swabs and napkins, etc.;
• exposure to various physical factors, which include drying of the serous membrane under the influence of air, especially with the laparotomy method of access, burns using an electric and radio wave knife, laser radiation, plasma scalpel, electrocoagulation and other methods of coagulation of small bleeding vessels, rinsing with hot solutions;
• aseptic inflammatory process in the abdominal cavity under the influence of previous factors, as well as intraperitoneal hematomas and minor hemorrhages, treatment of the peritoneum with alcohol or iodine, the use of various other concentrated solutions (antiseptics, antibiotics) for washing the abdominal cavity;
• the use of long-term absorbable suture material, the presence of drainage in the abdominal cavity, talc from gloves, gauze or cotton pieces, etc.;
• oxygen deficiency of tissues and disorders of metabolic processes in them, as well as inappropriate gas temperature conditions when using CO 2 -pneumoperitoneum for diagnostic or therapeutic laparoscopy;
• postoperative infection, which occurs more often with laparotomic access than with laparoscopic.

All of these factors, and most often their combination, are a trigger that leads to inflammatory processes, which are the cause of excessive biological synthesis of connective tissue, that is, the formation of adhesions. In operative gynecology, the maximum impact of the first three factors occurs during hysterectomy, and therefore the prevention of adhesions after removal of the uterus is of greatest importance compared to other gynecological operations.

In obstetrics, delivery is carried out by caesarean section somewhat less associated with mechanical and physical damage to the pelvic organs. However, frequently occurring surgical blood loss causes tissue hypoxia, disruption of their metabolism and the body's immune response, which also contributes to the development of adhesions and adhesive disease in the immediate or late postoperative period. Therefore, prevention of adhesions after cesarean section should be carried out in the same way as with other surgical interventions.

Methods for preventing adhesive disease

Based on observations and taking into account the mechanisms of formation of the adhesive process, prevention of the formation of adhesions should be carried out already during the surgical intervention itself. It includes the following basic principles:

1. Reducing damage to the peritoneum due to careful treatment of tissues, reducing (if possible) the time of surgery, economical use of coagulation techniques and wound retractors. In addition, it is necessary to reduce the number of sutures and the application of clips, carefully stop bleeding without disrupting blood circulation in the tissues, remove all necrotic tissue and blood accumulations, suppress infection with low-concentrated antibacterial and antiseptic solutions, moisturizing tissues and washing the abdominal cavity, using suture material that does not cause an immunological reaction, preventing talcum powder and cotton dust from gauze wipes and tampons from entering the abdominal cavity.
2. Reducing the severity of inflammatory processes through non-hormonal and hormonal anti-inflammatory drugs.
3. Reducing the degree of primary response to aseptic inflammation.
4. Suppression of the cascade of increased blood clotting, reduction in the activity of fibrin formation and activation of processes aimed at its dissolution.
5. The use of agents aimed at reducing the accumulation of elastin and collagen proteins, which subsequently leads to the development of fibroplastic processes (fibrinolytic enzymes).
6. The use of the hydroflotation method, which consists of introducing crystalloid solutions (Ringer-lactate solution) or dextrans (icodextrin, etc.) into the abdominal cavity together with heparin and a solution of glucocorticosteroids in order to separate the contacting surfaces, activate the fibrinolytic activity of peritoneal cells and suppress the coagulation cascade.
7. The use of barrier preparations (gels, biodegradable membranes, hyaluronic acid, polyethylene glycol, as well as the introduction of surfactant-like agents, etc.), fixed on contacting surfaces in the abdominal cavity and pelvis and leading to their mechanical separation.

Thus, the main mechanism of importance in preventing adhesions is to minimize the trauma of surgical intervention. Surgical methods of prevention can be supplemented by other means and methods, which in no case can replace the first. In this regard, prevention of adhesions during laparoscopy has significant advantages.

The main advantages of the laparoscopic method in operative gynecology as a method that helps reduce the formation of adhesions are:

• minimal degree of traumatization of blood loss due to the absence of large incisions of the anterior abdominal wall in areas of abundant blood supply;
• minimal access, helping to prevent the possibility of penetration of ambient air and foreign reactive materials into the abdominal cavity, as well as drying out of the serous surface with the destruction of the phospholipid layer;
• the use of bipolar electrodes, which damage tissue significantly less than monopolar and ultrasonic electrodes, and prevent the formation of adhesions;
• work on organs and tissues magnified by an optical camera using instruments at a remote distance, thereby significantly reducing the risk of mechanical injury to the mesothelial layer;
• reduction of manipulations with distant organs and tissues;
• no need to isolate individual zones and floors of the abdominal cavity, for example, the intestines, with surgical drapes;
• more gentle and faster restoration of anatomical structures and peristaltic function of the intestine;
• the positive effect of laparoscopy itself on the activity of the peritoneum in terms of fibrinolysis (dissolution of fibrin).

At the same time, according to statistics, about 30-50% of all cases of pelvic pain occur after laparoscopy of ovarian cysts, fallopian tubes and other diagnostic laparoscopic procedures. This is mainly due to the fact that:

• carbon dioxide introduced into the abdominal cavity to provide laparoscopic access causes spasm of the capillaries of the superficial peritoneal layers, which leads to hypoxia and disruption of metabolic processes in the mesothelial layer; adding 3 percent oxygen by volume to carbon dioxide significantly reduces these phenomena;
• gas is introduced into the abdominal cavity under pressure;
• dry gas.

Thus, laparoscopic gynecology only slightly reduces the frequency and prevalence of adhesions, abdominal-pelvic pain syndrome and the frequency of re-operations associated with adhesions. Laparoscopic methods are not a reason to abandon the basic principles of preventing the formation of adhesions. The choice of additional anti-adhesion agents depends on the extent of surgical trauma.

Prevention of adhesive disease in the postoperative period consists mainly of:

• restoration of water and electrolyte balance in the body;
• carrying out anti-inflammatory and anticoagulant therapy;
• early activation of the patient;
• restoration of intestinal function as quickly as possible.

The principles of preventing the formation of adhesions are the same for all types of surgical interventions. Their use should be comprehensive and in accordance with the volume and nature of the injury.

30.10.2018

Adhesions are connective adhesions between internal organs, looking like peculiar films, provoked by fibrinogen, a special substance secreted by the human body that promotes healing of wounds. Adhesions can be either congenital or acquired after surgery. Blood or inflammatory fluid, without being resolved, gradually, from the 7th to the 21st day, thickens and is replaced by connective tissue. During this time, the adhesions go from being loose, which are easy to treat, to become dense, blood capillaries are formed in them, and after 30 days, nerve fibers are already present in the adhesions.

Reasons

More often, the adhesive process is provoked by operations, but other reasons for their appearance are also possible. Adhesions in the peritoneal cavity may remain after bruises or closed injuries abdomen, as a result of which the outflow of blood is disrupted, the lining surface of the abdominal cavity “dries out” and the internal organs, in the process of rubbing against each other without protective “lubrication”, “overgrow” with adhesions.

Less common are cases where adhesions formed as a result of aseptic inflammation in the abdominal cavity caused by the ingress of certain substances, such as alcohol, iodine or rivanol solution. By the way, these fluids can enter the peritoneum only during surgery.

Symptoms

As a rule, the entire adhesive process as such goes unnoticed. All signs by which the presence of adhesions in the body can be diagnosed relate to the complications they cause. Therefore, the symptoms are quite varied and depend on the location of the adhesions and the disorders they provoke.

Symptoms of abdominal adhesions:

• Low blood pressure;
• Sharp sharp pain;
• Increase in temperature;
• General weakness;
• Constipation.

The adhesive process in the intestines has similar symptoms and is much more difficult to diagnose. If treatment is not started on time, adhesions in the intestines can even degenerate into malignant tumor. The most common symptoms of intestinal adhesions are constipation with periodic pain, pain during exercise, and weight loss.

When the process is running, the symptoms are as follows:

• Intestinal cramps;
• Vomiting mixed with feces;
• Bloating;
• Increase in temperature;
• Pressure drop;
• Intense thirst;
• Drowsiness, weakness.

1. Adhesions in the lungs reveal themselves as pain when breathing, aggravated by the weather.
2. The adhesive process on the liver causes pain when inhaling.
3. Adhesions on the uterus cause pain during sexual intercourse.

Treatment methods

Treatment of adhesions depends not only on physical condition the patient, but also from the manifestations of the disease itself. Because main reason the appearance of adhesions is a surgical operation, then treatment should be therapeutic. Surgical methods for removing adhesions are used only in the most extreme cases when the patient's life is at risk.

At the first stages of the adhesive process, aloe preparations, vitamins E and folic acid. True, these remedies can only stop the development of new adhesions and make existing ones more elastic.

The adhesive process is usually treated with physiotherapeutic methods, such as:

• paraffin applications;
• ozokerite applications;
• electrophoresis with absorbable and analgesic drugs (calcium, magnesium or novocaine);
• enzyme therapy;
• laser or magnetic therapy;
• massage.

With all of the above, there are indications for surgical intervention to get rid of the adhesive process. Laparoscopic surgery is prescribed for acute adhesions (usually this becomes necessary in case of intestinal obstruction, when the attack cannot be relieved within 1–2 hours). Laparoscopy is also performed in case of obstruction of the fallopian tubes.

The actual treatment using laparoscopy involves cutting adhesions using an electric knife, laser or under water pressure. To prevent re-formation of adhesions in the postoperative period, special preventive procedures are prescribed.

Home Recipes for Treating Adhesions

Treatment of adhesions with home methods, herbal teas, lotions are very effective, it is especially good to use them in the postoperative period to prevent adhesions. Pharmacies offer a very wide selection of herbal medicines, but they are easy to prepare at home.

• Tea against pulmonary adhesions: 2 tbsp. l. rosehip and nettle, 1 tbsp. l. Combine lingonberries. Add to 1 tbsp. l. mixture 1 tbsp. boil water and leave for about 2-3 hours. Drink half a glass in the morning and evening.
• Flax lotion: 2 tbsp. l. Place flax seeds in a fabric bag and place in boiling water. Cool in water. Apply lotions to adhesions at night.
• St. John's wort decoction: In Art. l. St. John's wort add a glass of fresh boiling water, boil for 15 minutes. Drink 1/4 tbsp. 3 times a day.
• Herbal tea: Prepare a mixture of sweet clover, coltsfoot and centaury. In Art. l. pour about 200 g of boiling water into the mixture and leave in a thermos for 1.5 hours. Drink 1/4 tbsp on an empty stomach for a month. 5 times a day.

Treatment of adhesions with massage at home is possible only after consulting a doctor, otherwise, instead of healing, you can get a hernia. It is better to tape a strip of foil to the place of the scar.

Prevention of adhesions

Methods for preventing the development of adhesions aimed at reducing tissue damage during surgical operations, can be divided into two main groups.

They mainly include prevention of foreign objects, such as dressings, from entering the abdominal cavity, and thorough sanitation of the surgical space. In addition, careful control of bleeding and the use of appropriate antibacterial drugs are necessary.

To prevent the appearance of adhesions, the following drugs should be used:
Fibrinolytics;
Anticoagulants;
Proteolytic enzymes.

To create a barrier between internal organs, specialists use various chemicals, including anti-inflammatory and antihistamine drugs.
Immediately after the operation, physical procedures, such as electrophoresis with lidase, are very effective.

These are prevention methods that should be used by doctors. What can a patient do to avoid adhesions after surgery?

First of all, it is very important not to linger in the postoperative period and to begin restoring motor activity as early as possible.
You definitely need to follow a diet - eat little, but often. You should exclude from the menu foods the consumption of which can cause increased gas formation - grapes, cabbage, fresh black bread, beans, apples.

Treat constipation in a timely manner; bowel movements should be regular. Limit your physical activity In particular, never lift a load weighing more than 5 kilograms.

Typically, adhesions do not cause any particular complications and do not need to be treated. But, nevertheless, we should not forget that the human body is not just a set of organs, each performing its own function, it is an interconnected complex of them. Disturbances in the functioning of one system will necessarily entail the development of pathological processes in another. For example, many appendectomy surgeries provide an 80% chance that the patient will need to have gallbladder surgery in the future.

Many people are familiar with the term adhesions firsthand. They appear after any strip operation, and subsequently cause a person considerable anxiety. We will consider whether it is possible to prevent the occurrence of adhesions, what complications the adhesions process can cause, and what treatment methods are available

The appearance of adhesions

Despite the big leap in the development of medicine, any patient after abdominal surgery can expect such an unpleasant complication as adhesions. What are spikes and why do they appear? The fact is that all organs of the human abdominal cavity are covered with a protective serous membrane. After surgery, this membrane is damaged, and during healing, adhesions are likely to occur. They are whitish translucent films that rigidly fix the internal organs and prevent them from interacting correctly. Most often, adhesive disease is not so serious as to cause significant harm to health. But in some cases it can cause a lot of inconvenience and decreased performance. Drawing, aching pain appears with a sudden change in body position; a feeling of discomfort and sometimes severe pain may occur.

Prevention

For operations performed on internal organs, take utmost care not to allow foreign material to get into the open wound and to avoid drying it out. If these conditions are not met, the risk of adhesions increases significantly. Their appearance is also facilitated by the patient’s low mobility after the operation, so physical activity should begin as early as possible - this will significantly reduce the risk of adhesions. It is imperative to adhere to the prescribed diet so as not to overload the body. A course of treatment with anti-inflammatory drugs is carried out in order to avoid infections of internal organs. Immediately after discharge, physical therapy will be very effective: ultrasound, laser treatment, electrophoresis.

Treatment

If adhesions have already formed or their occurrence cannot be prevented, treatment with surgery may be necessary. The most gentle method is laparoscopy: adhesive joints are dissected through a small puncture using a miniature video camera. If the lesion is large, a surgical incision must be made to remove the connective tissue.

You can also try to treat adhesions with folk remedies. For example, this article talks about traditional treatment adhesions of the fallopian tubes in women.

Consequences

Do not neglect the doctor's prescription after surgery. By refusing postoperative prophylaxis and physical therapy, the patient may encounter a number of complications associated with adhesive disease. Abnormal bending or partial narrowing of the intestine, up to obstruction, which may require urgent surgical intervention. In women, adhesions on the internal organs of the small pelvis can lead to the risk of inflammation of the appendages and even infertility.

Very often, after being discharged from the hospital, people rush to quickly return to their daily rhythm of life, work and household chores, without thinking about the risk of complications. In order to preserve your future health, you just need to pay attention to yourself, try to organize your daily routine, start eating right and don’t forget about physical exercise.