Surgical Adhesions

By Meg Marinis, Director of Medical Research Feb 21, 2013
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I told you our doctors had a plan! I told you they wouldn't let Seattle Grace Mercy West go down without a fight! Now what eventually happened may not have been their exact original plan, but it worked, and now we've saved the hospital from people like Cahill, Pegasus, or even an outright auction. We can finally relax. 

We can finally return to what our hospital does best: Treating patients. Treating patients like poor Andy Carmichael who hopefully will not have to come back for ANOTHER intestinal surgery because of his consistent problem with adhesions.

What exactly are adhesions and how do they form?

Adhesions are bands of scar tissue that bind two parts of tissue or organs together in the body. They develop when the body attempts to repair itself after any disturbance such as surgery, trauma, infection, or radiation. Repair cells cannot distinguish between different parts of the body, so the scar tissue ends up forming and connecting multiple organs and tissues.

Adhesions can form anywhere, but they commonly develop in the abdomen, pelvis, and heart (Andy had them in his abdomen).

Some adhesions don't cause any symptoms, but many sufferers face chronic pain, intestinal obstruction (like Andy), and even infertility.

The pain can mimic other conditions such as appendicitis, diverticulitis, and endometriosis. But if someone presents with the following symptoms, one should see a doctor immediately to check for an obstruction:

• Severe abdominal pain or cramping.
• Vomiting.
• Bloating.
• Loud bowel sounds.
• Swelling of the abdomen.
• Inability to pass gas.
• Constipation.

The adhesions can kink, twist, or pull the intestines out of place, which causes the obstruction. Obstructions can be confirmed by imaging studies – an abdominal X-ray, a CT scan, or a lower GI series. Adhesions cannot be detected by imaging, but surgeons can find them through an exploratory laparotomy.

Adhesions can have an effect on a woman's reproductive system by preventing the fertilized eggs from reaching the uterus; they also can twist – similar to how they can with intestines – the fallopian tubes, which carry the eggs from the ovaries to the uterus.

Many adhesions can be approached conservatively, but some require surgical treatment.

If an adhesion causes a surgical emergency, such as an obstruction, surgery should be done to repair it. And while in the abdominal cavity, the surgeon can cut the adhesions free by a scalpel or by using an electrical current (called "Lysing"). However, with more surgery, more adhesions can form. Therefore, doctors can try certain techniques as a means of prevention. Laparoscopic surgery requires a smaller incision and disturbs the tissue less than traditional open procedures.

What was used in the show tonight?

Recently, doctors have also tried the method of implanting adhesion barriers when operating in the abdomen. One type of adhesion barrier is a wax-like film that the surgeon places in the abdomen over the incision site in order to keep the tissues and organs from sticking together while healing. And after several days, the film will naturally dissolve.

For more information on adhesions, please visit the following:

http://www.nlm.nih.gov/medlineplus/adhesions.html