Abdominal adhesion surgery at Leeds Hospital

What is abdominal adhesion surgery?

Abdominal adhesion surgery frees organs and bowel that have become stuck together by bands of scar tissue inside your tummy, called adhesions. Surgeons call the operation adhesiolysis, and its aim is to cut through these bands so your bowel can move and work normally again.

What conditions does it treat?

Surgeons use this operation to treat problems caused by adhesions, most commonly a blockage in the bowel that stops food and fluid passing through, known as intestinal or small bowel obstruction. It's also used for long-term abdominal pain linked to adhesions, and for adhesions in the pelvis or womb that are stopping you getting pregnant.

Adhesions themselves usually form after surgery on the abdomen or pelvis. Other causes include:

• a burst or infected appendix
• peritonitis, an infection of the lining of the abdomen
• endometriosis or pelvic inflammatory disease, the most common cause in women who haven't had surgery
• Crohn's disease or ulcerative colitis
• radiotherapy to the abdomen
• infections inside the abdomen, such as tuberculosis.

Rarely, adhesions form for no clear reason at all.

What are the benefits of having abdominal adhesion surgery?

The main benefit is relief from a bowel blockage, which can be life-threatening if it's left untreated. Surgery can also ease long-term pain caused by adhesions pulling on your organs.

If adhesions in your pelvis or womb are affecting your fertility, dividing them can improve your chances of becoming pregnant.

Are there different types of surgical approaches?

Surgeons can reach your adhesions in two ways: keyhole surgery (laparoscopy), using a few small cuts, or open surgery (laparotomy), using one larger cut. Keyhole surgery causes slightly fewer new adhesions than open surgery, but your surgeon may recommend open surgery if you're very unwell or if the operation is an emergency.

Whether your surgery is planned or urgent also affects the approach. If a blockage doesn't clear with hospital treatment within about 3 days, or your surgeon is concerned about your bowel, you'll usually be offered an operation on an urgent basis rather than waiting.

What happens before the operation?

Your doctor will start by asking about your symptoms and medical history, then examine your abdomen. You may also need a rectal examination, and women may be offered a pelvic examination; you can ask for a chaperone for either of these.

You'll usually have blood tests to check your general health, including signs of inflammation and how well your kidneys are working. A CT scan can show the site and severity of any blockage and check the blood supply to your bowel.

Imaging cannot show adhesions directly, so surgery may be the first time anyone can confirm they're actually there. If fertility is a concern, a scan called a hysterosalpingogram can check for blockages in your womb or fallopian tubes.

If you're admitted with a sudden blockage, initial treatment focuses on rest and rehydration: fluids into a vein, sometimes a tube through your nose to drain your stomach, and occasionally a dye test called a gastrografin challenge, which can clear a blockage without removing the adhesions themselves.

What happens during the procedure?

The exact steps depend on whether you have keyhole or open surgery, but the surgeon's aims are the same:

1. The surgeon reaches your adhesions through either several small cuts or one larger cut in your abdomen.
2. They free up the scar tissue that's binding your organs or bowel together.
3. They straighten out any twisted or kinked bowel and check it for damage.
4. a section of bowel has been damaged beyond repair, they remove it and rejoin the healthy ends, keeping as much bowel as possible.
5. Once your bowel looks healthy, the surgeon places it back into your abdomen and closes the cuts.

What does recovery look like?

In hospital, some people need feeding through a vein for a short time to let their stomach and bowel rest and heal; this is more likely if a large section of bowel was affected. You'll usually be ready to go home once your bowel starts working normally again.

At home, you may be advised to eat low-fibre, soft foods for a while before returning to your normal diet, and to drink plenty of fluids. If you need a specific diet longer term, ask your doctor to refer you to a dietitian; mild pain can usually be managed with paracetamol, with opioid painkillers best avoided as they can slow your bowel down.

Your surgical team will also want to monitor you afterwards, since adhesions can form again even after a successful operation.

What are the risks and complications?

Operating on the abdomen is itself one of the most common causes of adhesions, so surgery to remove them carries its own risks:

• new adhesions can form again after surgery, sometimes causing further pain or another blockage
• if adhesions return, you may need a repeat operation
• good surgical technique can lower the chance of new adhesions forming, but cannot prevent it completely.

Because of this, your surgeon will usually only recommend an operation when the benefits are likely to outweigh the risk of new adhesions forming, and will talk this through with you beforehand.