Lysis of adhesion is a surgical option for adhesion treatment where the surgeon cuts the adhesions to separate them. Adhesions are tough bands of fibrous scar tissue that form connections between organs and other structures inside the body. They can lead to a variety of complications including torsion, where organs twist in place, and separation of the adhesions is often the only way to resolve these complications. Treatment of adhesions was historically complicated because surgery can increase the risk of developing adhesions, and surgeons were often reluctant to operate for fear it could make the internal scarring worse. Advances in surgical treatment have made lysis of adhesion an option for treatment.
Adhesions can cause chronic pain, discomfort, and bowel obstructions. Most commonly, they are caused by trauma, including surgery, and in a patient with these symptoms, a history of trauma is a strong indicator that adhesions are present. Conservative approaches to treatment are generally attempted first but if they are not effective, lysis of adhesion may be recommended.
In a patient with suspected adhesions, the procedure can be done laparoscopically, through a series of small incisions to introduce tools, or with a laparotomy, where a single small incision is made to access the site. The surgeon looks inside, severs connections formed by adhesions, and may add special packing or gauze to decrease the risk the adhesions will reform after the surgery. This procedure is performed with the use of general anesthesia.
Recovery time varies, depending on the patient's overall physical condition before the surgery and the number of adhesions present. People will usually be advised to rest at first and then begin gentle exercise to prevent blood clots and similar complications of surgery. Manipulative therapy may be recommended to discourage the development of new adhesions after the procedure, if a surgeon feels this option is helpful for surgical recovery. Once patients are fully recovered, they can resume normal activities.
The risks of lysis of adhesions include adverse reactions to anesthesia, the development of infections, and the recurrence of adhesions. The reappearance of scar tissue is not a sign of surgical incompetence, as even very skilled surgeons with years of experience can see the development of new scar tissue in their patients. The mechanisms behind why adhesions form in some patients and not in others, and how they form in the first place, are not entirely understood. Improvements in surgical practices appear to have reduced the risks of initial adhesion formation, but these risks have not been eliminated.