Adhesion (medicine)
Adhesion (medicine) | |
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Adhesions formed following appendectomy |
Adhesions are
Pathophysiology
Adhesions form as a natural part of the body's healing process after
If this is allowed to happen, tissue repair cells such as macrophages, fibroblasts, and blood vessel cells penetrate into the fibrinous adhesion and lay down collagen and other matrix substances to form a permanent fibrous adhesion. In 2002, Giuseppe Martucciello's research group showed a possible role could be played by microscopic foreign bodies (FB) inadvertently contaminating the operative field during surgery.[4] These data suggested that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate foreign body (FB).
While some adhesions do not cause problems, others may prevent
Regions affected
Adhesive capsulitis
In the case of
Abdominal adhesions
Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures. The adhesions start to form within hours of surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and pulling of internal organs may result in complications such as abdominal pain or intestinal obstruction.
Small bowel obstruction (SBO) is a significant consequence of post-surgical adhesions. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. Obstruction may occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows the small bowel to twist spontaneously around itself and obstruct. Without immediate medical attention, SBO is an emergent, possibly fatal, condition.
According to statistics provided by the National Hospital Discharge Survey approximately 2,000 people die every year in the US from obstruction due to adhesions.[5] Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. Many obstructive events require surgery, however, to loosen or dissolve the offending adhesion(s) or to resect the affected small intestine.
Pelvic adhesions
Pelvic adhesions are a form of abdominal adhesions in the
Surgery inside the
The impairment of reproductive performance from adhesions may happen through many mechanisms, all of which usually stem from the distortion of the normal tubo-ovarian relationship. This distortion may prevent an
A meta-analysis in 2012 came to the conclusion that there is only little evidence for the surgical principle that using less invasive techniques, introducing fewer foreign bodies, or causing less ischemia reduces the extent and severity of adhesions in pelvic surgery.[7]
Pericardial adhesions
Adhesions forming between the heart and the sternum after cardiac surgery place the heart at risk of catastrophic injury during re-entry for a subsequent procedure.
Peridural adhesions
Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain.
Peritendinous adhesions
Adhesions and scarring occurring around tendons after hand surgery restrict the gliding of tendons in their sheaths and compromise digital mobility.
Association with surgical procedures
Applying
An unfortunate fact is, that adhesions are unavoidable in surgery and the main treatment for adhesions is more surgery. Besides intestinal obstructions caused by adhesions that may be seen in an X-ray, there are no diagnostic tests available to accurately diagnose an adhesion.[dubious ]
Abdominal surgery
A study showed that more than 90% of people develop adhesions following open abdominal surgery and that 55–100% of women develop adhesions following pelvic surgery.[13] Adhesions from prior abdominal or pelvic surgery may obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in British medical journal The Lancet, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery, due to adhesion-related or adhesion-suspected complications.[14] Over 22% of all readmissions occurred in the first year after the initial surgery.[14] Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.[15]
Certain organs and structures in the body are more prone to adhesion formation than others. The omentum is particularly susceptible to adhesion formation; one study found that 92% of post-operative adhesions were found in the omentum.[16] It appears that the omentum is the chief organ responsible for "spontaneous" adhesion formation (i.e. no prior history of surgery). In another study, 100% of spontaneous adhesion formations were associated with the omentum.[2]
One method to reduce the formation of adhesions following abdominal surgery is hydroflotation, in which the organs are separated from one another by being floated in a solution.[17]
Carpal tunnel surgery
The long-term use of a wrist splint during recovery from carpal tunnel surgery may cause adhesion formation.[18] For that reason, it is advised that wrist splints be used only for short-term protection in work environments, but otherwise, splints do not improve grip strength, lateral pinch strength, or bowstringing.[18] Beyond adhesion they also may cause stiffness or flexibility problems.[18]
Types
There are three general types of adhesions: filmy, vascular, and cohesive,[19] however, their pathophysiology is similar.[19][unreliable medical source?] Filmy adhesions usually do not pose problems. Vascular adhesions are problematic.
References
- ^ "adhesion" at Dorland's Medical Dictionary
- ^ PMID 11727863.
- S2CID 232124644.
- S2CID 26508386.
- ^ See article at: www.adhesions.org/ardnewsrelease092303.pdf
- PMID 11727865.
- PMID 22899657.
- ^ "Adhesion prevention: a standard of care". Medical Association Communications. American Society of Reproductive Medicine. February 2002. Archived from the original on 2018-12-01. Retrieved 2008-02-08.
- ^ a b "Adhesion Prevention: A Standard of Care". American Society for Reproductive Medicine. Medical Association Communications. Archived from the original on 1 December 2018. Retrieved 23 May 2014.
- PMID 18639246.
- ^ "Adhesions". Better Health Channel. Archived from the original on 5 October 2015. Retrieved 20 February 2014.
- ^ "Abdominal Adhesions (Scar Tissue)". Medicinenet. Archived from the original on 26 July 2017. Retrieved 20 February 2014.
- S2CID 30816909.
- ^ S2CID 9057821.
- S2CID 12022467.
- PMID 4580750.
- S2CID 21605591.
- ^ ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013, which cites
- Keith, MW; Masear, V; Chung, KC; Amadio, PC; Andary, M; Barth, RW; Maupin, K; Graham, B; Watters WC, 3rd; Turkelson, CM; Haralson RH, 3rd; Wies, JL; McGowan, R (Jan 2010). "American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome". The Journal of Bone and Joint Surgery. American Volume. 92 (1). American Academy of Orthopaedic, Surgeons: 218–9. S2CID 7604145.)
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: CS1 maint: numeric names: authors list (link
- Keith, MW; Masear, V; Chung, KC; Amadio, PC; Andary, M; Barth, RW; Maupin, K; Graham, B; Watters WC, 3rd; Turkelson, CM; Haralson RH, 3rd; Wies, JL; McGowan, R (Jan 2010). "American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome". The Journal of Bone and Joint Surgery. American Volume. 92 (1). American Academy of Orthopaedic, Surgeons: 218–9.
- ^ a b "Adhesions Overview". Women's Surgery Group. Archived from the original on 20 July 2014. Retrieved 23 May 2014.
External links
- eMedicineHealth: Adhesions, General and After Surgery
- Smith, Orla M., Getting adhesions unstuck, Science, November 30, 2018, volume 362, issue 6418, pp. 1014-1016