Adhesions after female surgery. Commissures

Adhesive disease of internal organs is quite common. It develops against a background of weakened immunity, after infections or surgical interventions. What are adhesions in gynecology, what symptoms do they show, and is there a favorable prognosis after treatment?

How does the process begin?

The main cause of adhesions is damage to the peritoneum.

The peritoneum is a thin serous membrane that lines the abdominal cavity and covers the organs located in it from all sides. This semipermeable membrane provides several important physiological functions:

1. Resorptive. Its surface is capable of absorbing secreted liquids, bacterial waste products, toxins, disintegrating protein structures of organs and blood elements.
2. Exudative. It secretes special substances - tissue fluids and fibrin for the intestine. They provide free sliding of tissues that come into contact with each other.
3. Barrier. Adhesions in the internal organs limit inflammatory and destructive foci, serve as biological protection against infections.
4. Plastic. If an irritant acts on the walls, the body is able to secrete fibrin and form adhesions (synechiae). So the peritoneum limits the spread of the infectious lesion, and after surgery "tightens", "seals" the seams.

When the inflammation lasts a long time, these transparent whitish films may fuse. This adhesive process is a kind of protective reaction of the peritoneum to the spread of infection in nearby organs.

Synechiae according to etiological signs are divided into congenital and acquired. By localization, adhesions are external (between the organs), internal (in the fallopian tubes, in the vagina, uterine cavity).

Process stages

Fibrinous films prevent the spread of inflammation, fuse together, form the so-called pockets. If treatment is not done on time, synechia affects the lower part of the uterus and the cervical canal, fallopian tubes.

In the development of the adhesive process in gynecology, several stages are distinguished:

1. On the first, thin bands are formed, filling no more than a third of the uterine cavity, and there are none in the tubes.
2. In the second adhesive process, half of the uterine cavity is covered, tubes are involved. The first signs of partial obstruction appear.
3. On the third synechia, the entire internal uterine surface is filled.

The disease interferes with the normal functioning of organs, violates intestinal motility. The female reproductive system becomes incapable of fertilization and conception.

Causes

Adhesion process in the body starts under the influence of several factors. They are conditionally divided into several groups:

1. The most common cause is an inflammatory focus in the pelvic organs (endometritis, salpingoophoritis).
2. Hidden genital infections, tuberculosis.
3. Intrauterine medical procedures with surgical interventions: curettage, abortion, hysteroscopy.
4. Injuries
5. Weakened immunity.

The provoking factors of the origin of the adhesive process include:

• Erratic sex.
• Failure to comply with hygiene rules.
• Frequent hypothermia.
• Malnutrition.
• Untimely treatment of infections.

As a rule, several causes form the development of pathology and the main one is inflammation. But if it is treated promptly and adequately, the growth of synechia can be avoided.

Symptoms

The severity of the adhesive process directly depends on the degree of its spread in the pelvic area. Variants of an asymptomatic course are often possible. Pathology can occur in three clinical forms:

1. Acute, extremely severe. Symptoms increase dramatically: pain predominates with bright dyspeptic manifestations, fever, tachycardia. Palpation of the abdominal wall painful. There are signs of bowel obstruction. The patient has pallor or cyanosis of the skin and mucous membranes, severe thirst. The acute form of adhesive pathology refers to emergency emergency conditions. The patient needs urgent hospitalization.
2. Intermittent (periodic). From time to time, a woman is bothered by pain in the lower abdomen, increased urge to urinate, upset stool (constipation or diarrhea), and a slight increase in temperature (37 ° - 37.3 ° C). In gynecology, conservative therapy is used to treat adhesions in the intermittent stage.
3. Chronic One of the most common forms of the pathological process. It does not give a clear clinical picture. The patient complains of minor, recurring pulling pains in the abdomen, constipation. There are irregularities in the menstrual cycle, accompanied by soreness. A woman suffers from infertility. Untreated chronic adhesive disease often recurs, so constant monitoring and adequate therapy for these patients is urgently needed.

Survey

In modern gynecology, at the initial stage, two main diagnostic methods are used: sonosalpingoscopy and salpingography.

For salpingographic research, a special radiopaque solution is used. After its introduction in the x-ray, it reveals seals and other growths. This procedure is prescribed before ovulation.

With sonosalpingoscopy, a special contrast solution is introduced before ultrasound examination.

On the usual survey ultrasound of the pelvic organs, the adhesion process is impossible to identify.

Treatment

After diagnostic measures and determining the degree of damage to the patient, a course of therapy is prescribed.

If synechiae are located on the walls of the tubes, and the formations do not interfere with the promotion of the eggs, conservative methods are used.

When the adhesion process captures the ovaries with the fallopian tubes, and the egg is not able to move, a surgical intervention is performed - laparoscopy.

The adhesioliolysis technique involves the removal of synechia using a special micromanipulator. This can be laser therapy (beam excision), aquadissection (water under pressure), electrosurgery (electric knife).

After the procedure, in order to prevent relapses, special solutions (Dextran, Povidin barrier fluids, mineral oils) are also introduced and treatment with polymer absorbable films is applied.

The following groups of medicines are used as adjuvant therapy:

• Fibrinolytics (chemotrypsin, urokinase, trypsin).
• Anticoagulants (Heparin).
• Antibiotics (tetracyclines, cephalosporins and sulfonamides).
• Antihistamines.
• Nonsteroidal anti-inflammatory drugs.

After conservative treatment or laparoscopy, the patient for six months is under the dynamic supervision of a specialist and undergoes a course of special gymnastics and physiotherapy.

Physiotherapy with electrophoresis, ozokerite and paraffin baths reduces pain, makes adhesions thinner, more elastic.

After a course of treatment, the patient is prescribed complete physical and emotional rest.

Prevention

Adhesive process is well studied, and modern laparoscopic treatment methods in combination with adjuvant therapy give a positive result.

In order to avoid relapse in the future, a woman must follow several important rules:

1. Visit a doctor every 6 months.
2. Adhere to a rational diet. Food should be fractional (5-6 meals) in small portions.
3. Exclude products that provoke increased gas formation.
4. Take electrophoresis with medications, massage, physical education every six months.
5. Timely treat urogenital infections.
6. Protect yourself from unwanted conception and prevent abortion.

If a woman is bothered by periodic abdominal pains, it is allowed to use antispasmodic drugs (No-shpu, Papaverin). With prolonged attacks, self-medication is unacceptable.

Adhesive disease is an insidious pathology, which under adverse circumstances can spread rapidly, leading to infertility, uterine bending, complete tubal obstruction, ectopic pregnancy.

If the adhesive process progresses in the abdominal cavity, we are talking about an extensive pathology. Recently, cases of morbidity in gynecology have become more frequent, the age category of patients is women 25-40 years old.

Causes of pathology

If adhesions are diagnosed in the small pelvis, which is obvious from the results of ultrasound, there can be several reasons for this anomaly. It:

• complication of the previous operation, surgical intervention;
• inflammation in the pelvic stage of exacerbation;
• sexual infection;
• abdominal hemorrhage;
• chronic endometriosis;
• trauma to the pelvic organs;
• mechanical manipulations of the uterine cavity;
• ectopic pregnancy.

Women who have personally encountered such problems in their general well-being fall into the “risk group”, therefore they must regularly perform ultrasound examinations and adhere to the rules of prevention. If the pathological process is already progressing, the symptomatology depends on the area of \u200b\u200bthe lesion and the form of the disease.

Symptoms of pathology

The disease begins with an acute attack. If untreated, the pain syndrome grows, and the diagnosis can eventually become chronic. In order not to hesitate with resuscitation measures, it is important to know the forms of the adhesive process in the small pelvis.

1. In the acute form, the adhesion process is accompanied by pain of various intensities, which provide a sharp deterioration in well-being. The temperature regime is violated, shortness of breath appears, the pulse quickens, painful palpation of the abdomen may indicate intestinal obstruction. Among the complications, doctors distinguish renal failure, insist on immediate treatment with conservative methods.
2. In the chronic form of the adhesive process in the small pelvis, the symptoms are weak, reminiscent of premenstrual syndrome. Pay attention to periodic pains in the lower abdomen, problems in the work of the intestines and bladder. Pain is not excluded with a sharp change in the position of the body, during intercourse.
3. Intermittent form of the disease is accompanied by a violation of the digestive tract. Chronic constipation alternates with indigestion, pain in the lower abdomen appears only from time to time, is not characterized by increased intensity.

The general well-being of the patient leaves much to be desired. If you are unable to determine your own form of diagnosis, it is important to remember the following disturbing symptoms:

For the prevention and treatment of DISEASES OF THE JOINTS, our regular reader uses the non-surgical treatment method, which is gaining popularity, recommended by leading German and Israeli orthopedists. Having carefully studied it, we decided to offer it to your attention.

It is additionally important to note: at the time of the attack, the pains are cutting in nature, remind of oneself with frequent “contractions”, and do not subside when the body position changes. The patient may think that her stomach just hurts; but taking antispasmodics does not provide positive dynamics.

Methods of home self-medication are completely excluded, with inept involvement, they can cause the patient to be hospitalized with subsequent surgical intervention

Many women know how adhesions in the small pelvis hurt, so they certainly will not confuse this unpleasant sensation.

Diagnosis and treatment

If there is a suspicion of the presence of adhesions in the pelvis, the first step is to conduct an ultrasound of the indicated area. The foci of pathology are clearly visible on the screen of the device, have excellent color and obvious signs of inflammation. A final diagnosis will be made possible by laparoscopic examination, as one of the most informative invasive methods. With the help of potential video equipment and the skillful actions of the surgeon, one can not only visualize adhesions of different sizes, but also determine their exact location in relation to neighboring organs.
To differentiate adhesions in the pelvis, there is a need for PCR diagnostics, which eliminates urogenital infections, as the main pathogenic factor. Additionally, it is recommended to perform a smear from the vagina and MRI according to indications. In the adhesive process of the peritoneal region, the choice of treatment is carried out only by a competent specialist, procrastination and superficial self-medication is dangerous for the patient's life and health.

Types of effective treatment

In the chronic adhesive process, conservative therapy is aimed at determining the pathogenic factor, its further elimination from the patient's body. Positive dynamics is achieved due to intensive antibacterial therapy, taking corticosteroids and anti-inflammatory drugs is also appropriate. If the disease worsened against the background of chronic endometriosis, the intake of synthetic hormones is mandatory.
At an early stage of the disease, doctors try to limit themselves to enzyme therapy, the main drugs of which break down adhesions of relatively small sizes. If drug treatment was ineffective, surgery is indicated for the indications. At the first stage, it can be external magneto-laser and inside laser therapy, which do not require prior hospitalization.
If such medical manipulations turned out to be in vain, laparoscopy with subsequent excision and removal of adhesions of the small pelvis is appropriate. This procedure provides three options for operable actions:

1. Electrosurgery, during which adhesions are dissected using an electric knife.
2. Laser therapy, where the excision of adhesions is performed by a laser.
3. Aquadissection, where adhesions are eliminated by the flow of water under pressure.

The final choice of the method is due to the features, localization and severity of the pathology of the retroperitoneal space. If the operation is not performed in a timely manner, healthy organs and tissues can be involved in the adhesion process, infection of the body is not excluded. After any surgical operations, a rehabilitation period of 3 to 5 months is required, a regular visit to the gynecologist, once the focus of the pathology is monitored on an ultrasound machine.

Prevention and Complications

If you ignore the prescribed treatment, do not notice the growing pains of the lower abdomen and hesitate to visit the gynecologist, serious health complications arise. This is diagnosed infertility, tubal obstruction, inflammatory processes, ectopic pregnancy, intestinal obstruction, displacement of the uterus, irregular menstrual cycle with severe pain.

If we talk about prevention, a regular visit to a gynecologist, timely treatment of all urogenital infections, pregnancy planning and a stable choice of sexual partner are indicated. Otherwise, it is better not to delay the treatment, since the pain in the pelvic area during the formation of adhesions becomes simply unbearable for the patient.

Surgery is a serious test for the body. General anesthesia, surgical trauma can have not only immediate, but also long-term consequences. These include, first of all, cosmetic defects that arise as a result of incision and connection of tissues with suture material. Surgical interventions in the intestine often lead to another long-term pathology - adhesive disease, in some cases requiring immediate surgical treatment.

What are spikes

The intestine is the longest anatomical formation of the human body. It is located in the abdominal cavity and is adjacent to the liver, spleen, stomach, ureters, bladder, uterus and ovaries in women and seminal vesicles in men.

All these formations are covered with peritoneum on the outside.  The latter is a combination of strong fibers of connective tissue. It has a smooth surface with an insignificant layer of serous fluid, as a result of which the abdominal organs can move relatively painlessly relative to each other. First of all, this applies to intestinal loops, round-the-clock promoting the food lump by wave-like wall contractions - peristalsis.

Adhesion can affect all parts of the intestine.

Adhesive bowel disease is a medical term used to describe the pathological process, which consists in the formation between the peritoneum and loops of the intestine of connective tissue cords - adhesions, which are subsequently prone to inflammation.

Forms of adhesive bowel disease

Doctors distinguish several forms of adhesive disease.

1. According to the localization of the pathological process in the intestine, adhesive disease is classified:
   • sigmoid colon - penultimate segment of the gastrointestinal tract;
   • rectum - the final section of the intestine;
   • large intestine - the widest section of the gastrointestinal tract;
   • small intestine - the main factory for the digestion and absorption of nutrients;
   • intestines and organs of the reproductive system of women - ovaries and fallopian tubes;
   • mesentery, in which the pathological process affects a specific anatomical formation of the abdominal cavity, consisting of vessels carrying blood to the walls of the hollow organs of the abdomen, on all sides wrapped in connective tissue - the peritoneum;
2. By the nature of the course, adhesive bowel disease is divided into:
   • acute form, in which the signs of the disease, requiring urgent surgical intervention, dominate;
   • chronic form, characterized by a wave-like course with periodic exacerbation and subsidence of clinical manifestations.

Reasons and development factors

Adhesive bowel disease has several causes. The peritoneum performs not only the function of ensuring mobility of the abdominal cavity organs, but also the task of delimiting the inflamed area. The body minimizes and eliminates any pathological process, preventing the spread of the infectious agent to healthy tissues.

The inflammatory process leads to the deposition on the surface of the peritoneum of a specific substance - fibrin. Subsequently, this site is populated by a multitude of cells producing connective tissue-fibroblasts. So commissures are formed.

Fibroblasts produce adhesion fibers

It should be noted that the body's ability to respond in this way to the presence of a pathological focus is laid at the level of genes that transmit information from generation to generation. However, the intensity of this process is individual for each person. The formation of adhesions under the influence of hereditary causes can occur from birth (congenital adhesive disease of the intestine) or during life (acquired form).

Intestinal adhesions - a consequence of the inflammatory process

Factors leading to the formation of intestinal adhesions are, in essence, the causes of the formation of inflammatory areas in a limited abdominal cavity:

Clinical manifestations of adhesive disease

Adhesive bowel disease does not always lead to the appearance of any negative signs.  Often this process is detected by chance during routine examinations or repeated surgical interventions on the abdominal organs.

The most acute situation occurs if connective tissue cords create an obstacle to the advancement of the digestive lump. A similar process leads to bowel obstruction, which requires immediate medical attention. In this case, the following clinical signs are observed:

The sudden disappearance of these symptoms, as a rule, speaks only of an aggravation of the clinical situation and the development of necrosis of intestinal loops that have fallen into the pathological focus.

In other cases, adhesive bowel disease occurs for a long time in the form of a series of activation and subsidence of negative manifestations. An exacerbation is usually accompanied by the following symptoms:

abdominal pain of various localization and intensity;

chair retention;

loose stools;

the inability of a woman to become pregnant due to lesions by adhesions of the fallopian tubes.

The clinical signs of acute and chronic form in adults and children are similar.

Video: clinical aspects of adhesions in the intestines

Diagnostic Methods

To establish the correct diagnosis, the following measures are necessary:

interrogation of the patient with the clarification of all the details of the development of the disease, as well as previous episodes of surgical interventions, injuries and infectious processes;

palpation examination of abdominal organs - allows you to localize painful areas, as well as identify the main symptom - muscle tension of the abdomen;

Palpation of the abdomen - the main method of objective examination

gynecological examination - reveals the presence of problems with the conception and gestation of pregnancy as a manifestation of the adhesive process;

panoramic radiographic examination of the abdominal organs - reveals a picture of intestinal obstruction (the presence of horizontal fluid levels in the intestinal loops);

Horizontal fluid levels are signs of bowel obstruction

ultrasound examination of the abdominal organs - allows you to detect indirect signs of adhesive disease in the form of an inflection of the wall of the hollow organs, as well as localize the former or current inflammatory process;

computed (magnetic resonance) tomography - helps to study in detail the anatomical structure of the abdominal organs;

CT scan of the abdominal organs - the main method for visualizing the anatomical structures of the abdominal cavity

diagnostic laparoscopy - allows, through several punctures under video control, to localize the adhesion process in the abdominal cavity;

Laparoscopy is an accurate method for diagnosing adhesive bowel disease

colonoscopy - helps under video monitoring to study the internal lumen of the intestine and identify places of adhesive deformities.

Treatment methods

Treatment of adhesive disease is a complex process that takes place under the supervision of a gastroenterologist, and, if necessary, a surgeon and gynecologist.

Drug exposure

To eliminate the negative symptoms of adhesive bowel disease, drugs from the group of painkillers and antispasmodics are used. In addition, these medications are used to prepare the patient for surgery.

Table: Drug Administration for Adhesive Bowel Disease

Drug name	Active substance	Release form	Mechanism of action
Ketanov	Ketorolac	Injection, tablets	Pain management
Nimesil	Nimesulide	Granules for suspension	Pain management
metamizole sodium; pitophenone hydrochloride; fenpiverinia bromide.	Tablets, injection	Pain management
Papaverine hydrochloride	Injection, rectal suppositories, tablets	Bowel Muscle Relaxation
Metamizole sodium	Injection, tablets, rectal suppositories	Pain management
Diclofenac	Diclofenac Sodium	Tablets, injection, rectal suppositories	Pain management
Ibuprofen	Ibuprofen	Capsules, tablets, powder, rectal suppositories	Pain management
Injection, tablets	Bowel Muscle Relaxation
Paracetamol	Paracetamol	Injection, tablets, rectal suppositories, powder, syrup	Pain management
Dufalac	Lactulose	Syrup
Smecta	Smectite dioctahedral	Powder suspension	Liquid Stool Elimination
Glycerin suppositories	Glycerol	Rectal suppositories	Laxative for constipation
Castor oil	Common Castor Oil Seed Oil	Capsules, oil for oral administration	Laxative for constipation
sodium citrate; sodium lauryl sulfoacetate; sorbitol solution.	Rectal solution	Laxative for constipation
Sea buckthorn suppositories	Sea buckthorn oil	Rectal suppositories	Laxative for constipation
Forlax	Macrogol	Powder	Laxative for constipation
Motilium	Domperidone	Suspension tablets	Regulation of intestinal motility
Iberogast	Extracts of medicinal plants	Drops for oral administration	Regulation of intestinal motility

Photo gallery: adhesion treatment preparations

  Drotaverin - a reliable antispasmodic
  Analgin is a powerful painkiller
  Baralgin effectively eliminates pain
  No-spa eliminates spasms of smooth muscles
  Microlax has a quick laxative effect
  Spazgan - a combined analgesic and antispasmodic drug
  Papaverine is used to relax the intestinal muscles.

Surgical intervention

Surgical treatment of adhesive bowel disease can be carried out by a surgeon urgently (with intestinal obstruction) or in a planned manner.

The elimination of adhesions consists in their dissection.  To access the pathological focus, an incision on the anterior abdominal wall (laparotomy) or several punctures under video control (laparoscopy) can be used. Separation of connective tissue cords is carried out using surgical instruments, as well as in a non-contact way - by directional laser radiation or by introducing a liquid into the cords (hydraulic squeezing).

Surgical intervention is to separate adhesions

The type of anesthesia is selected by the doctor individually based on the nature and extent of the intervention.

In the postoperative period, it is necessary to limit physical activity, to monitor regular bowel movements.

Diet

hard boiled eggs, soft-boiled and omelettes;

dairy products;

chicken broth;

boiled chicken and turkey meat;

steamed sea fish.

  Chicken eggs - part of the diet of patients with adhesive disease
  Chicken stock is good for adhesive disease
  Boiled chicken - a dietary product
  Sea fish - a source of valuable protein
  Sour-milk products must be actively included in the diet for intestinal diseases
  Omelet is recommended for use with adhesive disease as a light and nutritious dish

Fermentation products should be avoided. These include:

• grapes;

  white cabbage;

  radish, turnip and radish;

  spicy spices;

  carbonated drinks;

  strong coffee and tea;

  fatty broths.

Photo gallery: products forbidden by adhesions in the intestines

  Grapes in any form are contraindicated in adhesive disease
  Cabbage - the cause of flatulence
  Turnip use contributes to increased gas production
  Strong tea - a sharp activator of peristalsis
  Carbonated drinks are not recommended because of the irritation of the intestinal mucosa that they provoke.
  Legumes are undesirable for adhesive disease

Non-drug methods

Physiotherapy is a very effective way to treat adhesive bowel disease:

• The enzyme preparation Lidaza, by means of direct electric current of the electrophoresis apparatus, penetrates the epicenter of the pathological process and destroys the connective tissue cords.
• The elimination of inflammation as the main cause of adhesion formation is promoted by magnetotherapy (Almag apparatus).

Physical therapy is one of the components of the treatment of the disease.

An approximate set of exercises for adhesive bowel disease:

Folk remedies

With the permission of the doctor, folk remedies are used in therapy, at the initial stage facilitating the manifestations of adhesive intestinal disease:

2 tbsp. l a mixture of equal parts of nettle leaves, rose hips and lingonberries must be poured with a glass of boiling water and insisted in a thermos. Take the drug in half a glass twice a day.

Shredded root of the incense in the amount of three tablespoons must be filled with 300 ml of boiling water and insisted in a thermos. The resulting product is filtered and taken one teaspoon before each meal.

Photo gallery: Plants for the treatment of adhesive bowel disease

  Lingonberry - a storehouse of nutrients and a powerful anti-inflammatory component of medicinal fees
  Nettle is effective for adhesive disease
  Rosehip contains Vitamin C - a natural antioxidant
  As a raw material for medical fees use the root of the incense

Complications and consequences

In severe course of adhesive bowel disease, the following complications may develop:

acute intestinal obstruction;

necrosis (gangrene) of intestinal loops;

widespread inflammation of the peritoneum (peritonitis);

the formation of conglomerates from several organs affected by a single adhesive process;

the formation of new adhesions after surgery;

inflammation of the proper connective tissue cords.

The inability to conceive a child and bear a pregnancy can be a serious problem in the presence of adhesive bowel disease. Deformation of the uterus and tubes prevents the egg and sperm from meeting. In addition, the presence of adhesions in the abdominal cavity is fraught with many technical complications during cesarean section: injured intestines, bladder, ureters and large vessels.

Adhesive bowel disease does not prevent breastfeeding.

Connective tissue cords covering the surface of the pelvic organs and connecting them together. Adhesive process is manifested by constant or periodic pelvic pains, miscarriage or infertility, intestinal disorders in the form of constipation, rapid stool and flatulence. When making a diagnosis, bimanual examination, ultrasound and pelvic tomography, hysterosalpingography, diagnostic laparoscopy are used. Conservative therapy includes the appointment of antibacterial, anti-inflammatory, hormonal and fibrinolytic agents. Surgical treatment is based on laparoscopic dissection of adhesions.

General information

Treatment of adhesions in the pelvis

Therapeutic tactics are determined by the stage, nature of the course, clinical severity and the presence of complications. At the initial stage of treatment of chronic adhesive disease, complex conservative therapy is recommended, which includes:

• Antibacterial drugs. Assigned with confirmation of the leading role of infectious agents in the development of adhesions, taking into account the sensitivity of microorganisms.
• Nonsteroidal anti-inflammatory drugs. Effectively eliminate severe pain. Relieve swelling and accelerate the resorption of adhesions in the initial stages of the disease.
• Hormonal drugs. Hormone therapy is indicated in the adhesion process that arose against the background of external genital or extragenital endometriosis.
• Fibrinolytic enzymes. Split glycopeptide bonds in connective tissue cords, which contributes to the complete or partial resorption of adhesions.
• Vitamins, immunocorrectors.They are used to improve overall well-being and correct possible immune disorders.
• Physiotherapy, balneotherapy.They are used as auxiliary methods of treatment.

With the ineffectiveness of medical treatment of the chronic form of the disease, acute and intercurrent pathologies, surgical intervention is indicated. Endoscopic surgery is usually used to dissect adhesions. Often laparoscopy is a medical diagnostic procedure, connective tissue adhesions are dissected directly during the examination. Depending on the instruments used, such interventions can be laser surgical, electrosurgical and aquadissection. In the latter case, adhesions are destroyed by increased water pressure. With a common adhesive process, alternative laparoscopy options are performed: double with atypical points of trocar injection, open (minilaparotomy) with direct trocar injection, with the creation of high pressure pneumoperitoneum. Operations with dissection of adhesions with a scalpel are rarely carried out these days.

Forecast and Prevention

With adequate treatment in the early stages of the disease, the prognosis is favorable. Surgical dissection of adhesions allows you to eliminate or significantly reduce pain and in 50-60% of cases restore reproductive function in women with stage 1-2 of adhesive disease. The use of an anti-adhesive gel barrier minimizes the risk of relapse. Prevention of the occurrence of adhesions in the pelvis includes scheduled examinations by a gynecologist to detect and treat inflammatory processes, rejection of unreasonable invasive interventions, pregnancy planning, and the use of contraceptives during sexual intercourse with random partners. To reduce the likelihood of peritoneal pelvic adhesions, during operations in women it is important to choose the most sparing type of intervention, treat inflammatory complications in a timely manner, and observe the motor regimen in the postoperative period.

  2017-08-25T22: 48: 24 + 00: 00

What are adhesions in gynecology? Adhesive process - these are fragments of scar tissue that bind 2 organs, which normally should not be connected. For example, intestinal loops and uterus, ovary, fallopian tubes.

Adhesions can appear in the form of thin cords, barely noticeable during laparoscopy, but they often look like dense, well-supplied adhesions. Adhesions develop in response to any influences in the body that require recovery processes. Such effects include surgery, inflammation, endometriosis, trauma or exposure to ionizing radiation.

Although adhesions can occur anywhere, one of the most common locations where they form is the pelvic organs.

Adhesive process and the fight against its consequences have long been one of the leading places in abdominal surgery. Adhesions in the abdominal cavity are a frequent complication of operations and occur in 55-93% of cases after gynecological operations. Adhesions in the abdominal cavity are also observed in approximately 10% of people who have never had surgery.
Fortunately, most patients with intra-abdominal adhesions are asymptomatic.

However, the adhesion process of the pelvic and abdominal organs is associated with significant gynecological morbidity, including infertility, chronic pelvic pain, small bowel obstruction, as well as potential surgical complications in the future.
The urgency of the problem today is as high as ever, since convincing data have been obtained that the frequency of clinically significant adhesions after gynecological operations does not decrease as we would like, but invariably increases, which is manifested in an increased frequency of hospitalizations and repeated surgical interventions associated with adhesions process.

This, apparently, is associated with the widespread occurrence of laparoscopy in gynecology, primarily surgery for infertility, ovarian cysts, and endometriosis. In addition, the incidence of myomectomy among women who have previously been offered a hysterectomy is increasing annually. Previously, only highly qualified surgeons operated in specialized centers with microsurgical equipment and carefully adhering to the principles of adhesion prevention described below.

Nowadays, almost any operating gynecologist performs these operations, often neglecting proper preventive measures.
Adhesion is seen as a natural consequence of surgical trauma and repair processes. The classical ideas about the causes of the adhesion process distinguish several main sources of adhesion formation, such as trauma to tissues of any origin (mechanical, thermal, infectious process, ionizing radiation, reaction to a foreign body, etc.).

Such an injury is a trigger of the cascade of reactions, which begins with the destruction of mast cells, the release of histamine and increased permeability of the vascular wall. Then fibrin is deposited. Peritoneal healing is a combination of fibrosis and mesothelial regeneration. Fibrinous deposits form within 3 hours after surgery. If fibrin lysis has not occurred, blood vessels sprout into these clusters and fibroblasts migrate.

Most fibrinous deposits are temporary and resolve within 72 hours, but the inhibition of peritoneal fibrin destruction caused by trauma leads to the formation of adhesions.
This point of view, which has become classical, has been confirmed in a series of experiments on animals, where the use of silicone membranes, uncoupling injured peritoneal surfaces for 30 hours, led to the absence of adhesions.
There is evidence that complements the concept of local origin of adhesions.

It is believed that the entire peritoneum can be a significant cofactor in the process of adhesion formation. The following factors promoting adhesion were identified: desiccation, hypoxia, acidosis, active oxygen radicals, and tissue manipulation, which leads to increased local adhesion formation.

Gel Intercoat (Oxiplex / AP)

Glossary:

Infiltrative endometriosis refers to clonal diseases. The disease begins with the appearance of a single cluster of endometrial cells, no larger than 1 cm.




Doctors associate the signs and symptoms of adhesive disease not with the problems that appear due to the presence of adhesions in the pelvic cavities, but from the compression of organs and tissues, which leads to functional disorders




Intercoat Adhesive Gel is a clear, single-use, viscous gel. It consists of a compound of polyethylene oxide (PEO) and sodium carboxymethyl cellulose (CMC).

Questions from patients and answers from doctors

Can the spikes resolve themselves?2017-09-22T17: 28: 44 + 00: 00

It develops in most women after undergoing surgical procedures of a diagnostic or therapeutic nature and, according to the duration of the disease, is divided into acute and chronic.

The "young" adhesive tissue formed during the first three months after the onset of the disease sometimes undergoes reverse development as a result of an intensive course of correctly selected therapy.

The most effective types of therapy for adhesive disease include physiotherapy and absorbable therapy, carried out in combination with anti-inflammatory drugs. It has a good effect on "young" adhesions and hirudotherapy - treatment with leeches, as well as gynecological massage.

However, in the presence of a chronic adhesive process, only surgical treatment can destroy adhesions, since the adhesive tissue in this case is characterized by increased density, the absence of any elasticity and usually does not respond to conservative therapeutic methods.

Is it possible to see pelvic adhesions on ultrasound?2017-09-22T16: 33: 10 + 00: 00

Like many other studies, ultrasound has its advantages and disadvantages.

The advantages of the study include its non-invasiveness, painlessness and informational content.

The disadvantages are the impossibility of determining a newly formed inflammatory tissue - for example, adhesions in the acute stage of adhesive disease. "Young" adhesive tissue has a low density and high plasticity, in contrast to mature adhesions in the chronic stage of the disease. Therefore, newly formed adhesions are practically invisible to ultrasound, especially if they are single.

Mature adhesive tissue is rigid and dense, so it is clearly distinguishable by ultrasound.

Additional examination methods, such as MRI and laparoscopy, are needed to clarify the diagnosis of pelvic adhesions.

Adhesions - what is it? How are they formed?2017-09-12T22: 14: 44 + 00: 00

Sometimes you have to deal with diseases that make you feel unwell, but to realize that this is completely impossible without the help of a doctor. There is an erroneous opinion that it is better not to have an idea of \u200b\u200bsome ailments for your own peace of mind. But if you learn in time about the changes that occur with the body, then you can prevent the aggravation of the disease. The treatment provided at the right time will have a beneficial effect. In this article, we will talk about the causes of adhesions.

Very thin fibers form in the body, and then films capable of gluing nearby organs. Thus, the operation of a certain system is disrupted. Most often, this disease affects the fair sex. Adhesions appear mainly in the small pelvis. But sometimes they arise in other systems.

One of the most common causes of this ailment is inflammation. At this time, any organs slightly increase in size. In the process, liquid begins to stand out. It is such mucus that turns into thin threads. Subsequently, films are formed - adhesions connecting the organs together or the organ with the peritoneum.

What are the differences between Intercoat Gel and Antiadhesin Gel?2017-09-12T20: 34: 26 + 00: 00

By anti-adhesive action, the drugs are similar. Intercote and Antiadhesin showed positive qualities. Both drugs have positive reviews. Both effectively prevent the development of adhesions.

Preparations differ in their chemical and pharmaceutical composition:

• Release agent : Hyalouranic acid + carboxymethyl cellulose. Sometimes it can provoke a tissue reaction to a foreign body, which ends with fibrosis of the surfaces of organs in contact with a barrier agent.
• : A barrier anti-adhesive agent based on a copolymer of carboxymethyl cellulose with polyethylene oxide showed in the study the absence of inflammatory reactions and the least likelihood of fibrosis.

How to use the gel? Please send your doctor recommendations for use2017-09-06T14: 39: 35 + 00: 00

Instructions for using Intercoat anti-adhesive gel can be found on our website.
Also, full instructions in Russian are in each package with gel

Can I have sex with spikes of the pelvis?2017-09-22T17: 50: 20 + 00: 00

Sexual life with a regular partner is not contraindicated in women suffering. Full sex has a special therapeutic effect, positively affecting the endocrine and psychological status of both partners.

However, it should be remembered that in the chronic stage of the adhesive process, dyspareunia may appear - a painful sexual intercourse when a woman experiences repeated pain in the lower abdomen and rectum.

Dyspareunia is the “hallmark” of adhesive disease and can completely disappear after surgical treatment.

Is it possible to get pregnant with adhesions of the fallopian tubes?2017-09-22T16: 23: 03 + 00: 00

The onset of pregnancy with adhesions in the fallopian tubes largely depends on a timely diagnosis, individually selected treatment, a full course of examination and the severity of the disease.

Sluggish, chronic infections, as well as endometriosis, can cause serious inflammation of the mucous membrane in the fallopian tubes, which can result in the formation of adhesions. Adhesions located in the cavity of the fallopian tubes sometimes completely overlap their lumen. In this case, the advancement of the egg through the tubes becomes impossible and the woman becomes infertile. However, adhesive disease in the fallopian tubes can be expressed to a weaker degree, and then the likelihood of pregnancy remains.

How to prevent adhesions?2017-09-06T14: 17: 23 + 00: 00

Many scientists and surgeons spent their whole lives on resolving this issue.

Today in the world, despite the achievements of modern science and medicine, there are no reliable and highly effective means of preventing the development of adhesions after operations.

Patients complain of abdominal pain, often in the area of \u200b\u200bpostoperative scars. The pain can be aching or pulling, aggravated by physical exertion, a change in body position, pass independently or after taking painkillers.

Pain form of adhesive disease may be with dysfunction of the internal organs. As a result of the adhesive process, the work of the organs of the gastrointestinal tract is disrupted. Manifestations can be various:

• diarrhea
• constipation
• bloating after eating,
• intolerance to certain types of food.

How do adhesions appear?2017-09-06T14: 18: 10 + 00: 00

Manifestations of adhesions depend on where the adhesions formed and how many of them formed. The extent to which the functions of organs that are soldered together are affected depends on this.

The most significant consequences of adhesion occur in the abdominal cavity, therefore these manifestations are called adhesive abdominal disease.