WOMENS-HEALTH Messages for May, 1998: Re: adhesions

Re: adhesions

From: J.Glenn Bradley MD (anonymous@obgyn.net)
Sun, 17 May 1998 00:29:59 -0500 (CDT)

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In reply to: Rachel: "adhesions"

At Sat, 16 May 1998, Rachel wrote: >
>Last May, I had a laparoscopy which diagnosed endometriosis and
>adhesions binding the large intestine and pelvic wall. I felt no relief
>after the surgery and pain continued to increase. I had a second lap
>last month which showed no signs of endo but adhesions in the same place
>only more dense. The surgeon/gyn said that the adhesions only need to
>be cut, not removed. I began having recurring pain within a week after
>all other post-surgery pains were gone. He says the adhesions were
>coincidental and could not have been due to lack of removal last
>time...that adhesions only form when there is infection or endo, not
>from so called "tags" that re-attach after surgery. What are the facts?
>Where can I find research to back it up? What do I do now?

Rachel: Adhesions begin to form within hours of surgery. We know that generally speaking, the more tissue injury in the abdomen, the greater the tendency for adhesion formation. Thus , again generally speaking, laparoscopic surgery is associated with a lesser tendency for adhesion formation, as opposed to a large laparotomy incision. Unfortunately some individuals have a greater tendency for adhesion formation than others, despite the extent of the surgical procedure.IMHO, I have re-laparoscoped patients with this proclivity for adhesions within 7 days, as the adhesions if present are wispy, not dense, not vascular, and easily swept aside. I am also careful to consider a nerve interruption procedure (if appropriate and indicated)in an efort to provide longterm pain relief. I always recommend that any procedure be videotaped, as a (moving) picture is worth a thousand words if a second opinion is needed. Your consultant is literally there, and able to offer his/her best opinion based on the actual pelvic situation, as opposd to relying on a written description of what was found.

Dr.B

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In reply to: Rachel: "adhesions"

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