Perioperative management - Adhesiolysis, open

Intra-abdominal adhesions occur in approx. 90% due to previous traumas, such as in every abdominal procedure. Only approx. 10% of all people have adhesions without prior manipulation in the abdomen; these can be congenital or also arise from intra-abdominal inflammations.

The majority of adhesions cause no symptoms whatsoever and have no pathological significance. An indication for adhesiolysis therefore exists only if the following symptoms occur:

• mechanical ileus
• symptomatic patients with passage disorders
• very cautious indication in patients with chronic abdominal pain caused by adhesions
• in every second procedure in the abdomen
• in some cases of female infertility

An adhesiolysis in patients with chronic complaints should only be performed as a last resort.

If an abdominal procedure is medically indicated and the patient is operable according to general criteria, there is no further contraindication.

There is no imaging procedure to qualitatively or quantitatively detect adhesions. Only an adhesion sonogram can provide an approximate indication of existing adhesions. In this process, the patient is sonographed in the supine position. Then, the patient is positioned on the side. If the small bowel loops shift less than 2 cm, adhesions are to be expected.

In mechanical ileus, abdominal CT provides the most information about the possible genesis.

Otherwise, for planned procedures, the specifically required examinations are performed.

There is no special preparation for adhesiolysis, it depends, as mentioned above, on the type of planned operation.

As a rule of thumb, elective procedures, e.g., the treatment of an incisional hernia, should be performed, if possible, at the earliest one year after the last operation, since empirically the adhesions then have their final state and can be released more easily.

Independent of the planned procedure, these specific risks apply:

• Injury to abdominal organs, here specifically small and large intestine
• The necessity to possibly resect intestinal segments.
• The fact that adhesions can generally recur in varying degrees even after successful adhesiolysis.
• if necessary, creation of an enterostoma
• Peritonitis due to overlooked intestinal leaks
• postoperative intestinal atony
• Persistence of adhesion complaints
• postoperative ileus approx. 1% within the first year and approx. 3% in the further course