Is there still pain after abdominal surgery? This could be due to abdominal adhesions!

Have you ever had a stomach ache or a feeling of fullness after a stomach operation, even years later? Sometimes the reason for this may not be what you think. Today we are talking about a condition called 'adhesions' that many people are not aware of, but which often occurs after surgery.

What are these abdominal adhesions?

Simply put, these are bands of scar tissue that form between the organs inside your abdomen. Just like a scar forms when our skin is injured, this is scar tissue that forms as an injury heals inside the abdomen, especially after surgery. These adhesions can cause the organs inside the abdomen to stick together.

These adhesions often form between loops of your small intestine. They can also form between another organ in your abdomen and the abdominal wall.

When we say the organs inside our stomach, you think of:

• Digestive system (stomach, intestines)
• Organs of the female reproductive system
• Kidneys
• Liver
• Pancreas
• Spleen

Adhesions can form between any of these organs. They can even occur due to manipulation of the organs during surgery. In fact, this is a natural part of the body's healing process.

How common are these adhesions?

These adhesions are the most common side effect of abdominal surgery. In fact, most people who have had abdominal surgery develop these adhesions. But the good news is that most people don't have any symptoms and don't need treatment.

What symptoms occur if there are adhesions?

Most of the time, adhesions don't cause any symptoms. But sometimes, these adhesions can cause our intestines to become twisted and blocked, like a water pipe. This can happen shortly after surgery or years later. When the intestines become blocked in this way, food, fluids, air, and waste can't pass through.

Then you may experience symptoms like these:

If you have any of these symptoms, do not waste time and go to the nearest hospital Emergency Department (ETU) immediately. This is a potentially life-threatening emergency.

Why do these adhesions occur? What are the causes?

When the tissues inside the stomach are damaged, our body begins to heal it. As part of this healing process, this scar tissue, or adhesions, are formed.

The main cause of adhesions is abdominal surgery. Surgery accounts for 75% of all diagnosed adhesions. In addition, they can be caused by any injury, disease, or treatment that causes inflammation inside the abdomen.

Some other reasons are:

• Infections of the abdomen or pelvis.
• Appendicitis.
• Crohn's disease.
• Endometriosis.
• Pelvic inflammatory disease (PID).
• Radiation therapy to the stomach for cancer.
• Peritoneal dialysis is a treatment for kidney failure.

Who is at higher risk of developing these?

The greatest risk is for those who have had abdominal surgery, especially:

• Open surgery (Laparotomy): This is surgery done through a single large incision in the abdomen. More than 90% of people who have this type of surgery develop adhesions.
• Laparoscopic surgery: Since this is done through several small incisions, the risk of developing adhesions is slightly lower.
• Surgeries performed on the lower part of the digestive system (colon, rectum).
• If you have had multiple abdominal surgeries.
• Emergency surgery.

What complications can occur due to adhesions?

Most of the time, adhesions don't cause problems, but if they do, they can be serious.

• Small bowel obstruction: Scar tissue can cause the intestines to become twisted and blocked. If not treated immediately, a serious infection called peritonitis can develop, which can be life-threatening.
• Chronic pain: Adhesions prevent organs from moving freely, which can cause chronic pain in the abdomen or pelvic cavity.
• Infertility: Adhesions can prevent the egg and sperm from meeting. If adhesions form inside the uterus, a fertilized egg (embryo) cannot implant in the uterus. These adhesions that form inside the uterus are also called Asherman's syndrome .

How does a doctor find this?

Your doctor will ask you about your symptoms and medical history. Your doctor may suspect adhesions, especially if you have had abdominal pain and previous abdominal surgery.

• X-rays and CT scans: These can show blockages in the small intestine. A CT scan can help determine the severity of the blockage.
• Hysterosalpingogram (HSG): This test is done to check for blockages in the uterus or fallopian tubes.

Ultimately, the only way to know for 100% certainty whether you have adhesions is to have surgery.

Do I need to treat this?

Many adhesions are asymptomatic and do not require treatment.

And there's another thing. If you have another surgery to remove the adhesions, it can cause new adhesions to form. This is a very delicate decision. A surgeon can cut and separate the stuck tissue. But once the surgery is done, there's no way to prevent the tissue from sticking together again.

Therefore, your doctor will only recommend surgery if there is a serious medical problem, such as a bowel obstruction. Also, if adhesions are making it difficult to have children, surgery will be performed to remove the adhesions.

Will these attachments ever go away? Is it unavoidable?

Some adhesions may heal on their own over time. Unless they are causing problems, doctors usually don't remove them.

However, even though there is a risk of further adhesions, sometimes surgery is necessary. Your doctor will explain the pros and cons of surgery to you, depending on your symptoms.

There is really nothing you or your surgeon can do to prevent adhesions. However, laparoscopic surgery has a lower risk of adhesions because the incisions are smaller. That is why many surgeons are now choosing laparoscopic surgery over open surgery.

Abdominal Adhesions, Abdominal Pain After Surgery, Small Bowel Obstruction, Laparotomy, Laparoscopy, Surgical Complications