Adhesiolysis

Written by Staff | 30 October 2011

Adhesiolysis, also commonly known as lysis of adhesions (LoA), refers to the process of cutting away internal scar tissue (adhesions) that commonly form after trauma, infection, inflammation or surgical procedures¹. Surgery is perhaps the most common cause of adhesions, which form adjacent to a site of incision as part of the healing process. Adhesiolysis is performed to restore normal function of affected tissues and relieve any pain associated with the development of adhesions¹.

Adhesiolysis is perhaps most relevant to small bowel obstructions, a common disorder (particularly amongst the elderly) in which the small intestines become mechanically or functionally unable to pass digested material². The majority of these obstructions are caused by post-surgical adhesions of the small intestines; one study estimated the risk of developing an obstruction from adhesions to be as high as 42% following an abdominal surgical procedure^{2, 4}.

Adhesions can also develop within the uterus, and may be asymptomatic or can cause issues such as infertility, menstrual irregularity, pelvic pain, or loss of pregnancy⁵. They typically occur after traumatic injury to the uterus, but can manifest following curettage (scooping) procedures within the uterus or as a complication of infection such as tuberculosis.

Adhesions are also seen in common conditions of low back pain, such as spinal stenosis (narrowing of the spinal canal), as a result of local inflammation that induces scar tissue formation³. These adhesions are thought to affect the mobility of spinal nerve root, contribute to pain, and can also act as obstacles to injection therapy. Adhesiolysis can also be performed in conjunction with epidural injections and other treatment modalities to help relieve lower back pain associated with spinal stenosis and related pathology, while simultaneously making therapeutic injections possible³.

The Procedure

Intra-abdominal adhesiolysis can be performed with sharp scissors or a scalpel after openly and surgically exposing the tissue (a laparotomy), or it can be performed much less invasively with a technique known as laparoscopy¹. With laparoscopy, cameras and instruments are inserted through smaller openings into internal tissues, and adhesions can be grasped and cut with scissor or cauterization attachments to the instruments⁴. By avoiding large surgical incisions, laparoscopy can lower the potential for future post-surgical adhesions. This procedure is performed under general anesthesia¹.

Intra-uterine adhesiolysis is generally done after cervical dilation provides direct visualization of the adhesions⁵. Adhesions are usually banded and excised with surgical scissors, with special care taken to restore normal uterine anatomy without perforating the uterus. Re-formation of intra-uterine adhesions can be prevented after adhesiolysis via temporary hormone therapy and catheter placement⁵.

Adhesiolysis of adhesions seen in low back pathology is typically performed via a procedure termed epiduroscopy in conjunction with epidural injection³.

Adhesiolysis is a surgical procedure, and thus not without risk. Complications are rare, but occasionally include internal organ injury, worsening of adhesions or development of new adhesions, bleeding and infection¹.

References

1. Shannon, D. (2010). Lysis of Adhesions. Baptist Health Systems, Retrieved from mbhs.org/healthgate/GetHGContent.aspx.
2. Berger, D.; et al. (2007). Gastrointestinal Surgery. Townsend: Sabiston Textbook of Surgery, 18th Ed. MD Consult Web site, Core Collection.
3. Igarashi, T.; et al. (2004). Lysis of adhesions and epidural injection of steroid/local anaesthetic during epiduroscopy potentially alleviate low back and leg pain in elderly patients with lumbar spinal stenosis. Br. J. Anaesth, Vol 93(2), pp. 181-187.
4. Hodin, R.; Bordeianou, L. (2011). Small bowel obstruction: Causes and management. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
5. Shelly, W.; Cedars, M. (2010). Intrauterine adhesions. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.