Adhesions After Hysterectomy

Reproductive Health
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Hysterectomy Scar Adhesions

Adhesions after hysterectomy are scar tissues that formed after surgery, allowing bodily tissues that are normally separated to stick and grow together. As a result of trauma following hysterectomy, the peritoneum membrane covering the pelvic organs becomes inflamed and subsequently leads to the formation of scar tissue that adheres the tissues together.

Adhesion represents a significant cause of morbidity in patients following gynecological procedures such as a hysterectomy. About fifty percent of patients with adhesion-related small bowel obstruction had previous gynecological surgery. Total abdominal hysterectomy has been found to be commonly associated with small bowel obstruction.

Symptoms

Intermittent pain in the pelvic area, infertility and small bowel obstruction are the common complaints of patients following a hysterectomy which should alarm the doctor to investigate for hysterectomy scar adhesions.

If the adhesion takes place in the small bowel, it is likely for the patient to develop intermittent attacks of cramps, associated with nausea, bloating sensation and even vomiting. The intestinal symptoms of adhesion are closely related to the extent of bowel blockage that prevents the bowel contents to pass through it despite the peristalsis movement. Bowel obstruction can be life threatening if left untreated and a patient usually appears ill and presents with forceful projectile vomiting, abdominal pain but not passing flatulence.

The range of morbidity associated with adhesion can be from chronic pelvic pain to infertility.

Treatment for Adhesion Following Hysterectomy

Treatment for complicated adhesion with bowel obstruction should focus on decompressing the bowel obstruction. A patient is put on naso-gastric suction to expel the accumulated gas and fluid in the stomach while intravenous fluids and antibiotics are administered. Input and output of body fluids are monitored by inserting a urinary catheter. The spectrum of treatments for a small bowel obstruction ranges from conservative management with bowel rest to surgical intervention.

There are various types of surgeries which can be done:

i) Duodenal Resection for Duodenal Obstruction.

ii) A Bypass Surgery: Gastro-Jejunostomy if it is unable to remove the site of obstruction.

iii) Laparotomy in case of complete bowel obstruction.

Treatment for uncomplicated adhesion depends on the extent of adhesion as well as the symptoms experienced by patients. While pelvic pain can be controlled by NSAIDs, some patients find acupuncture equally promising.

Essentially, the treatment of choice for adhesion after hysterectomy is adhesiolysis, that is to separate or remove adhesions surgically. Patients with pelvic pain associated with severe adhesion experience a marked improvement of symptoms following laparoscopic adhesiolysis. Apart from that, up to sixty percent of infertility cases attributed to pelvic adhesion were successfully treated with adhesiolysis. Laparoscopic approach for adhesiolysis is a more popular choice as compared to the open adhesiolysis simply because it can be done electively. Faster recovery time also lowers the incidence of infection and pain.

Precautions of Hysterectomy Adhesions Recurrence

Postoperative reformation of hysterectomy adhesions is a common occurrence. Thus, only patients with clear indications should be considered for adhesiolysis as the risk of recurrence may outweigh the benefits.

References

  1. Adhesive Disease in Obstetric and Gynecologic Surgery: Epidemiology, Pathogenesis, Consequences, and Prevention. Kathleen A. Carroll, MD; Resad Pasic, MD

  1. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol 1999;180:313-5. Al-Took S, Platt R, Tulandi T.

  2. Preventing intraperitoneal adhesions with atorvastatin and sodium hyaluronate/carboxymethylcellulose: a comparative study in rats. Am J Surg. Jul 2010;200(1) Lalountas MA, Ballas KD, Skouras C, et al.

  3. Open Adhesiolysis by Brian James Daley, MD, MBA, FACS, FCCP