Intestinal and pelvic adhesions after surgery: from what appear and what to treat

Thin films of connective tissue between internal organs are adhesions. They occur most often after surgery. Let's consider the features of their appearance and treatment.

The internal organs of a person are covered on the outside with a thin membrane that separates them from each other. A small amount of liquid and smooth tissues ensure the displacement of organs during movements.

Normally, after the operation, the internal organ is scarred, and the period of its healing is called the adhesion process. That is, connective tissue adhesions (similar to polyethylene film or fibrous stripes) are physiology that goes away on its own and does not interfere with the functioning of the body.

As the pathological process develops, the cords stick together, disrupting the normal movement and functioning of organs. After surgery, they are most often diagnosed on the following organs:

• Appendix and intestinal lesions lead to organ obstruction and require additional surgical treatment.
• Formations in the pelvis can significantly disrupt a woman’s health and the ability to conceive a child.
• Inclusions in the ovaries or tubes - occur due to inflammation of the appendages or infectious lesions and can lead to infertility.
• Without timely diagnosis and treatment, this threatens serious complications and severe pain.

Why are adhesions dangerous after surgery?

Very often patients wonder what is dangerous about adhesions after surgery. So, if the strands appear in the abdominal cavity, for example, in the small intestine, then this negatively affects the functioning of the digestive system. Such neoplasms complicate any surgical interventions in the abdominal cavity, significantly increasing the risk of organ perforation and bleeding.

Connective tissue inclusions in the peritoneum are dangerous because they can cause intestinal obstruction and intestinal obstructions. Neoplasms bend and stretch individual parts of the intestines or organs, disrupting their functioning. In this case, a life-threatening condition is complete intestinal obstruction.

The growth of connective tissue on the respiratory organs causes respiratory and cardiovascular failure. Due to the disruption of local blood supply, tissue necrosis and the development of peritonitis are possible. Formations on the pelvic organs are quite dangerous. Thus, adhesions of the ovary, uterus or intestines can cause obstruction of the fallopian tubes and infertility.

Epidemiology

According to medical statistics, the epidemiology of adhesions is associated with surgical intervention in 98% of cases. Adhesive disease affects women more often (after appendectomy and operations on the uterus and appendages) than men (abdominal trauma).

• After surgery on abdominal organs, 80-85% of patients develop adhesions in the small and large intestines.
• Repeated laparotomy results in adhesion formation in 93-96% of patients.
• After appendicitis, intestinal adhesions appear in 23% of those operated on after a year and in 57% after three years.
• After gynecological pathologies, in 70% of cases, cords appear on the uterus and ovaries.

The formation of collagen fibers begins on the third day of the pathological process, and connective tissue adhesions appear from the 7th to the 21st day. During this time, loose strands are transformed into dense scar tissue, blood vessels and even nerve endings appear in them.

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Causes post-op adhesions

There are a number of factors that affect the growth of connective tissue in internal organs. The causes of adhesions after surgery largely depend on the surgeon's professionalism. Most often, the pathological condition occurs when:

• Inflammatory and infectious complications.
• Bleeding in the abdominal cavity.
• Trauma to the abdomen and pelvic organs.
• Long-term tissue ischemia.
• Foreign objects in the wound.
• Violations of surgical technique.

The adhesion process can be provoked by the patient himself, due to failure to follow the doctor's recommendations for recovery after surgery. Cords form after appendicitis, ectopic pregnancy or abortion, with intestinal obstruction, endometriosis and ulcerative lesions of the stomach.

Based on this, we can conclude that postoperative inclusions are formed for many reasons. Without timely diagnosis and treatment, they impede the functioning of internal organs, which leads to various complications.

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Risk factors

The proliferation of connective tissues of internal organs is in most cases associated with surgical intervention, but there are other risk factors. The pathological condition is possible with:

1. Cords in the abdominal cavity can form with bruises and abdominal trauma. Hemorrhages in the retroperitoneal space and hematomas in the mesentery lead to lymphostasis and impaired blood outflow. In turn, this leads to impaired exudation into the abdominal cavity. As a result, the internal organs are left without natural lubrication, begin to rub against each other and fuse.
2. Abdominal obesity - excess fatty tissue in the area of the omentum magnum, i.e. the folds behind the visceral sheet of the peritoneum and the closing loop of the intestine, can provoke connective tissue adhesions. The loose tissue of the omentum is especially sensitive to the formation of strands due to the pressure of fatty deposits in the abdominal area.
3. Adhesions can occur during inflammatory processes. For example, with chronic cholecystitis, adhesions appear not only on the gallbladder, but also on the liver, stomach, duodenum, and omentum. Most often, this is observed after influenza, dysentery, or Botkin's disease.
4. Another risk factor is congenital malformations of the abdominal organs. As a rule, adhesions are diagnosed in the area of the ileum and cecum.
5. Some chemicals promote the formation of cords. For example, alcohol, Ravinol and iodine lead to aseptic inflammation of the abdominal cavity. Most often, these fluids enter the peritoneum during surgery.

In addition to the above factors, there is a huge risk of adhesions after laparotomy. Any operation on the abdominal organs is associated with mechanical trauma to the peritoneum. At the same time, the rougher the surgeon works, the higher the risk of pathological adhesions. The disorder occurs due to a violation of the body's fibrinolytic system.

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Pathogenesis

The mechanism of development of internal organ cords is associated with cellular and humoral processes. The pathogenesis of adhesions after surgery is based on the disruption of the local balance between fibrin synthesis and fibinolysis, i.e. its breakdown. Surgical interventions lead to damage to the mesothelial layer of tissues and blood vessels. As a result, an inflammatory reaction and activation of inflammation mediators and the formation of blood clots occur.

The permeability of blood vessels gradually increases, and damaged tissues secrete serous-hemorrhagic exudate (contains leukocytes, thrombocytes, interleukins, macrophages, fibrinogen, hyaluronic acid, proteoglycans). Under normal conditions, fibrin is lysed, but due to the operation, fibrinolytic activity decreases, and excess fibrinogen is transformed into a kind of gel that covers the affected tissues. Gradually, fibroblasts grow and adhere to each other, transforming into internal scars, i.e. adhesions.

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Symptoms post-op adhesions

The duration of formation of connective tissue adhesions directly depends on the affected organ. Symptoms of adhesions after surgery most often manifest as painful sensations in the area of the surgical scar.

The most common symptoms of postoperative distress are:

• Nausea and vomiting.
• Violation of defecation.
• Lack of stool.
• Regular constipation.
• Painful sensations when palpating the surgical suture.
• Increased body temperature.
• Difficulty breathing and shortness of breath.
• Redness and swelling of the outer scar.

Initially, there are no pain symptoms, but as the scar thickens, they become pulling. Discomfort increases with physical exertion and any movements. For example, after surgery on the liver, lungs or pericardium, pain occurs with a deep breath. If adhesions form on the pelvic organs, pain is possible during intercourse. The clinical picture depends on the localization of the strands and the general condition of the body.

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First signs

Very often after surgery, patients face such a problem as connective tissue adhesions between adjacent organs or surfaces. The first signs of the adhesion process are manifested by cramping pains in the area of the scar. The discomfort is aching in nature and increases with physical exertion.

The pathological condition is accompanied by bouts of nausea and vomiting. Abdominal bloating and frequent constipation are possible. The paroxysmal pains weaken and recur. Because of this, the patient becomes irritable, and changes in body weight are possible due to lack of appetite. As the disease progresses, disorders of the cardiovascular and respiratory systems appear.

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Pain from adhesions after surgery

Symptoms such as pain from adhesions after surgery occur in many patients. The discomfort is paroxysmal and cutting. At the same time, taking antispasmodics and painkillers does not provide positive dynamics.

Depending on the pain, the following forms of adhesion process are distinguished:

1. Acute form – adhesions cause pain of varying intensity, which leads to a sharp deterioration in well-being. The temperature rises, shortness of breath appears, the pulse quickens. Attempts to palpate the postoperative scar cause severe pain. Against this background, intestinal obstruction and renal failure may develop.
2. Chronic form - if the cords have formed in the pelvis, then the symptoms of the disease are similar to premenstrual syndrome. There may be problems with the intestines and bladder. Pain occurs during sexual intercourse and when changing body position.
3. Intermittent form – characterized by pronounced disturbances in the functioning of the gastrointestinal tract. Chronic constipation alternates with stomach disorders. Pain occurs less frequently, but is quite intense.

In addition to pain, there are frequent attacks of nausea and vomiting, loss of appetite, possible loss of ability to work, migraines and dizziness.

Intestinal adhesions after surgery

Formations of connective tissue between intestinal loops and abdominal organs are intestinal adhesions. They appear most often after surgery. Surgical intervention leads to the gluing of serous membranes of organs to each other and to their functional disorders. In this case, the strands consist of the same tissue as the outer wall of the intestine.

Consider the main reasons for the appearance of connective tissue adhesions in the intestine:

1. Surgical intervention - according to medical statistics, if a primary laparotomy intervention on the intestine was performed, inclusions are formed in 14% of patients. If this is the 3rd-4th operation, then soldering occurs in 96% of cases. The pathology is aggravated by infectious and inflammatory processes.
2. Abdominal trauma (open, closed) – very often mechanical damage leads to internal bleeding. Hematomas form on the intestines, lymphatic drainage and metabolic processes in the organ tissues are disrupted. Inflammation develops, which provokes an adhesion process.

In addition to the above-described reasons, the disorder may occur due to inflammation of the appendages in women, congenital anomalies in the development of the organ, foreign bodies in the peritoneum, or the use of certain medications.

Additional risk factors for adhesions after bowel surgery are identified:

• Ischemia of organ tissue.
• Application of non-absorbable sutures.
• Postoperative infections.
• Intraoperative trauma.
• Blood in the peritoneum after surgery.
• Hereditary predisposition to the formation of cords.
• Hyperactivity of connective tissue.
• Decreased local immunity.

The symptoms of the pathological condition are divided into several stages. The first thing the patient encounters is intestinal obstruction. There are paroxysmal pains in the abdominal area, which are accompanied by nausea and profuse vomiting. Asymmetrical bloating is possible. Palpation of the abdominal cavity causes severe pain. Early adhesive obstruction, as a rule, is formed against the background of an inflammatory process. If this condition is left without medical assistance, it will lead to intoxication complications and organ paresis.

Diagnosis of postoperative intestinal pathologies is based on characteristic symptoms, visual examination of the patient and collection of anamnesis. To clarify the diagnosis, plain radiography of the abdominal cavity, electrogastroenterography, ultrasound and MRI, laparoscopy are used. During the examination, it is necessary to differentiate the cords from other types of acute intestinal obstruction or tumor formations. Treatment is surgical, with a course of physiotherapy to prevent the proliferation of connective tissue.

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Adhesions after abdominal surgery

Almost every patient faces such a pathology as adhesions after abdominal surgery. The proliferation of connective tissue can lead to adhesive disease, which is accompanied by serious disruptions in the functioning of internal organs.

Adhesive process with a large incision in the abdominal wall, that is, after laparotomy, can occur for the following reasons:

• Inflammatory reactions.
• Infectious complications of surgery.
• Anti-clotting action.
• Increased protein levels in the blood.
• Individual characteristics of the organism.

If only one of the peritoneal layers is damaged during trauma to the peritoneum, and the one with which the internal organs are in contact is intact, then adhesions, as a rule, do not form. If adhesions do appear, this does not lead to dysfunction of the organs, since the strands are superficial and easily delaminate.

If two contacting sheets are injured, this triggers a series of pathological reactions. The disruption of the integrity of the blood capillaries is associated with certain blood proteins, and the adhesion of organs with coagulation factors and the action of globulins.

Connective tissue adhesions are small in size, but can lead to deformation of the organ structure. Clinical signs of the disease depend on the location and size of the adhesions. Most often, patients face the following problems: abdominal pain, deterioration of general health, constipation, nausea and vomiting. Painful sensations arise due to disruption of the functioning of the intestines, and, as a rule, they are paroxysmal. To diagnose the disease, anamnesis is collected and the patient is examined. Treatment is surgical.

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Adhesions after hysterectomy

Connective tissue seals that occur during surgical interventions and inflammatory processes are adhesions. After hysterectomy, they occur in 90% of women. Adhesions are a rather dangerous complication, as they can lead to functional disorders in the work of internal organs and even to severe intestinal obstruction.

Hysterectomy, i.e. removal of the uterus, is characterized by the formation of connective tissue scars at the site of incisions and scars. If the physiological process is complicated (infection, inflammation), then the fibrous strands continue to grow and grow into other internal organs.

The main reasons for the proliferation of connective tissue after removal of the uterus depend on the following factors:

• Duration of the operation.
• The extent of surgical intervention.
• Volume of blood loss.
• Endometriosis.
• Genetic predisposition to adhesive disease.
• Internal bleeding and wound infection in the postoperative period.
• Immune system disorders.

In addition to the above factors, the development of pathology largely depends on the actions of the surgeon. In some cases, the disorder occurs due to foreign objects in the abdominal cavity, for example, if fibers from a tampon or gauze, or talc particles from the surgeon's gloves get into the wound.

Signs of the development of a pathological process are manifested by the following symptoms:

• Pulling and aching pain in the lower abdomen. The discomfort is periodic.
• Urination and defecation disorders.
• Dyspeptic disorders.
• A sharp increase in temperature.
• Painful sensations during sexual intercourse.

If more than a month has passed since the hysterectomy and the above symptoms do not go away, you should immediately seek medical help. To diagnose the disorder in the postoperative period, the patient is prescribed the following examinations:

• Complex of laboratory studies.
• Ultrasound examination of the abdominal cavity and pelvic organs.
• X-ray of the intestine using contrast.
• Laparoscopic diagnostics.

Connective tissue adhesions are treated surgically. Dissection and removal of neoplasms are performed using laser therapy, aqua dissection, and electrosurgery. In the postoperative period, drug prophylaxis is indicated. The patient is prescribed broad-spectrum antibiotics and anticoagulants. Physiotherapy with electrophoresis of enzymes that destroy fibrin is also prescribed.

If adhesions in the uterus are left untreated, this will lead to the fallopian tube turning into a connective tissue sac. The organ will lose the ability to move fertilized eggs. In this case, even surgical treatment is not able to restore the functions of the fallopian tubes, which is one of the causes of infertility.

Adhesions after appendicitis surgery

One of the most common surgical interventions is appendectomy. Despite the simplicity of the procedure, the patient faces a long recovery period. Adhesions after appendicitis surgery are quite common and are one of the complications.

The proliferation of connective tissue is associated with irritation of internal organs due to mechanical impact on them. Dense strands gradually form on the membranes that cover the intestines. They grow among the internal organs, occupying a certain space. The pathological process is accompanied by damage to blood vessels and leads to deformation of the intestines due to the fusion of its loops with each other.

The appearance of cords after treatment of appendicitis is associated with the following factors:

• Removal of the appendix by open means rather than laparoscopy.
• Prolonged inflammatory process after surgery (peritoneal and intestinal tissues are affected by pathogenic microorganisms and their toxins).
• Genetic predisposition to increased activity of certain enzymes that accelerate the scarring process.
• Development of pathology due to medical error (for example, a napkin left in the abdominal cavity).
• Coagulation (cords may form when cauterizing blood vessels) or internal bleeding.

The painful condition manifests itself as nagging pains in the area of the postoperative scar and deeper in the abdomen. Against this background, symptoms from the gastrointestinal tract arise: bloating, nausea and vomiting. There is also a decrease in blood pressure and heart problems, general weakness. To diagnose connective tissue adhesions, an ultrasound examination of the abdominal cavity, collection of anamnesis, a set of laboratory tests, radiography and diagnostic laparoscopy are indicated.

Treatment depends on the diagnostic results. The patient is prescribed conservative therapy, which consists of taking medications, following a therapeutic diet and physiotherapy. In particularly severe cases, surgical treatment is prescribed. The operation is performed using a laser or an electric knife. The doctor dissects the adhesions, freeing the organs.

If appendicitis cords are left without medical care, this can lead to serious complications. First of all, this is intestinal obstruction due to compression of the organ loops. If the appendages, uterus or fallopian tubes are affected, infertility may develop. The most dangerous complication is tissue necrosis. Adhesions press on the tissue and compress the blood vessels, which leads to circulatory disorders. The bloodless area gradually dies.

Adhesions in the nose after surgery

Synechiae or adhesions in the nose after surgery are connective tissue cartilaginous or bone bridges between the mucous walls of the nasal sinuses. In addition to surgical intervention, neoplasms can also appear for the following reasons:

• Intrauterine developmental disorders and genetic pathologies.
• Chemical or thermal burns of the mucous membrane.
• Infectious diseases.
• Regular nosebleeds.
• Syphilis.
• Scleroma.

Some patients do not experience discomfort from the cords, as they are soft and thin. But most often, patients face the following problems:

• Difficulty breathing through the nose.
• Voice change.
• Dry throat in the morning.
• Complete or partial perception of smells.
• Inflammation of the upper respiratory tract.
• Inflammation of the paranasal sinuses.

Synechiae in the nasal cavity are differentiated depending on their location and the tissue from which they are formed. If the growths are formed in the vestibule of the nose, they are anterior, inclusions between the nasal conchae and the septum are median, and formations in the choanae are posterior synechiae. The latter type of adhesions is the most dangerous, as they can completely or partially block the air supply from the nose to the pharynx.

Connective tissue strands are also distinguished, which have a soft texture and are easy to dissect. More dense and bone neoplasms most often act as a sign of congenital pathology and require surgical treatment. To diagnose postoperative adhesions in the nose, you should consult an otolaryngologist. Using rhinoscopy, the doctor determines the presence of pathology. It is also necessary to pass a set of laboratory tests that will identify inflammatory processes and other disorders.

Treatment is carried out only surgically, since neoplasms do not resolve on their own. For this, a classic operation may be prescribed, that is, removal with a scalpel, laser removal or radio wave exposure. Drug therapy is used only to stop the infectious or inflammatory process.

If the pathology is left untreated, it can lead to various ENT diseases (pharyngitis, otitis, pneumonia, bronchitis). In addition, insufficient ventilation of the paranasal sinuses is an ideal environment for infection, which can affect the ears and affect hearing quality.

Adhesions in the pelvis after surgery

Connective tissue adhesions in the pelvic organs are a common pathology among women, which leads to infertility. Adhesions in the pelvis after surgery occur due to tissue trauma and various inflammatory complications. Moreover, the longer and more traumatic the operation, the higher the risk of formation of bands.

The clinical picture of the adhesive process has several forms:

• Acute - the pain syndrome is progressive. Nausea and vomiting, elevated body temperature, increased heart rate appear. When trying to palpate the abdomen, sharp pains occur. Acute intestinal obstruction, general weakness and drowsiness, and urinary disorders are also possible.
• Intermittent form – periodic pain, there are intestinal disorders (diarrhea, alternating with constipation).
• Chronic – the symptoms of this form are hidden. Aching pain in the lower abdomen, constipation. Most often, this type of disorder is diagnosed by chance, during an examination when infertility or endometriosis is suspected.

Diagnosis is difficult. When initially seeking medical care, the doctor collects the patient's medical history and complaints. Bimanual examination reveals immobility of organs or their limited mobility. Ultrasound, MRI, laboratory tests and other examinations are also performed.

Treatment of pelvic cords after surgery consists of medical and surgical methods. The following methods are used to remove adhesions and separate organs: laser therapy, aqua dissection, electrosurgery. Conservative therapy is based on eliminating the inflammatory process. Patients are prescribed a therapeutic diet, physiotherapy procedures and a set of other measures for normal recovery.

Adhesions after gallbladder surgery

Formation of strands during cholecystectomy occurs in every third patient. Adhesions after gallbladder surgery are associated with several factors, let's consider them:

• Trauma and contusions of the peritoneum that disrupt the outflow of blood from the tissues lining the surface of the abdominal cavity.
• Aseptic inflammation caused by the entry of certain substances (alcohol, iodine or rivanol solution) into the peritoneum during surgery.
• Inflammatory infiltration in the surgical area.
• Chronic cholecystitis causes cicatricial changes in the gallbladder, which significantly complicates the process of its removal and recovery after surgery.
• Atypical anatomical structure of the organ, its vessels and bile ducts.

Risk factors for the development of adhesions include advanced age, excess body weight, and chronic diseases. The painful condition may be associated with blood or inflammatory fluid that did not dissolve after surgery, but thickened and was replaced by connective tissue.

Symptoms of the ligaments after gallbladder surgery are manifested by a decrease in pressure, sharp acute pain, constipation, general weakness and an increase in temperature. If the pathology becomes chronic, the following symptoms occur: intestinal spasms, bloating, vomiting with feces, intense thirst, deterioration of general health.

Treatment depends entirely on the patient's physical condition and the course of the adhesion process. Anticoagulants, proteolytic enzymes, and fibrinolytics are indicated as drug therapy. In severe cases, surgery is performed. Particular attention is paid to prevention, which consists of a special diet and physiotherapy.

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Adhesions after ovarian surgery

There are a number of reasons why adhesions form after ovarian surgery. The main factor is a long-term inflammatory process, infection or complications during surgery. Among the possible causes of the disorder, the following are distinguished:

• Cervical erosion or cauterization disorders.
• Multiple ruptures sustained during childbirth.
• External endometriosis and blood entering the abdominal cavity.

The risk of postoperative adhesions directly depends on the individual characteristics of the patient's body and on compliance with medical recommendations after surgery. That is, abdominal trauma, various diseases of the pelvic organs, STDs, abortion, hypothermia and even long-term use of antibiotics can provoke the appearance of inclusions after ovarian surgery.

The pathological process goes through several stages in its development.

1. The cords are localized around the ovary, but do not interfere with the capture of the egg.
2. Tissue grows between the ovary and fallopian tube, creating an obstacle for the egg.
3. The fallopian tube becomes twisted, but its patency is not impaired.

The disorder is characterized by menstrual irregularities, nagging pain in the lower abdomen and lower back, discomfort during intercourse, and the inability to become pregnant for a long period of time. Since the symptoms may coincide with signs of other gynecological or endocrine pathologies, you should consult a doctor and undergo a thorough diagnosis.

To treat connective tissue adhesions, laparoscopy, laser therapy, electrosurgery or aquadissection, i.e. cutting of neoplasms with water, are used. The patient is prescribed a course of antibacterial therapy to suppress the infection, anti-inflammatory and fibrinolytic agents, anticoagulants and vitamins.

Adhesions after spinal surgery

Scars and adhesions after spinal surgery occur in almost all patients. This leads to narrowing of the spinal canal. Both infectious and autoimmune processes with impaired cerebrospinal fluid flow can develop at the site of the lesion. Fibrous strands fuse spinal roots with herniated intervertebral discs, epidural tissue and spinal cord membranes. Neoplasms can be either light or heavy and dense.

The main causes of adhesions in the spine:

• Traumatic hematomas.
• Infectious complications.
• Epidural administration of certain medications.
• Removal of intervertebral disc herniations.

The disease begins with aseptic inflammation. In the surgical area, swelling occurs, which affects the spinal root and surrounding tissues. Gradually, the inflammatory process passes into the fibroblastic stage, forming dense adhesions.

The cicatricial adhesion fixes the nerve root in one position, exerting increased pressure on it. This provokes pronounced painful sensations of varying intensity. Chronic pain is disguised as various diseases of the spine. For example, cords in the lumbar region are similar in pain to lumbago. Discomfort can spread along the sciatic nerve, both to one and to both legs. Without treatment, this condition leads to disruption of tissue nutrition and atrophic processes.

Adhesions after lung surgery

Such a problem as adhesions after lung surgery occurs in 30% of patients who have undergone surgery. The enlarged connective tissue strands are most often localized between the serous membranes of the pleural cavity. They can occupy all parts of the pleura (total) and individual cavities due to the adhesion of the pleural sheets. The strands form in any place where there is connective tissue.

In addition to chest surgery, inclusions may also occur for the following reasons:

• Pleurisy and previous pneumonia.
• Bronchitis (acute, chronic).
• Inflammation or cancer of the lungs.
• Congenital defects.
• Pulmonary infarction or parasitic infestation.
• Internal bleeding.
• Allergic reactions, smoking, occupational hazards.

The pathological condition has the following symptoms: shortness of breath, rapid heartbeat, respiratory failure, chest pain, various respiratory disorders due to impaired natural ventilation of the lungs. Deterioration of general health, cough, sputum production, elevated body temperature, oxygen starvation, intoxication.

The cords negatively affect the functioning of the respiratory organs, hinder their work and limit mobility. In some cases, complete overgrowth of the cavities occurs, which causes acute respiratory failure and requires urgent medical care.

To diagnose the disease, fluorography and x-ray of the lungs are performed. Treatment depends on the severity of the disease. Surgical intervention is indicated if tissue inclusions have caused pulmonary insufficiency and other life-threatening conditions. In other cases, drug therapy and a course of physiotherapy are performed.

Adhesions after stomach surgery

The abdominal organs are most susceptible to the appearance of postoperative cords. The neoplasms are localized between the intestinal loops, stomach and other organs, causing gradual fusion of serous membranes.

Adhesions after stomach surgery can be aggravated by the following factors:

• Abdominal injuries (open, closed).
• Increased synthesis of enzymes that provoke the proliferation of connective tissue.
• Inflammatory and infectious diseases of internal organs.
• Radiation therapy for oncology.

According to medical statistics, 15% of patients develop adhesions after surgical intervention. The clinical picture of the pathology is accompanied by the following symptoms: nagging pain, digestive disorders, intestinal obstruction, appetite disorders, sudden weight loss, problems with stool. Treatment can be both conservative and surgical, depending on the severity of the pathology.

Complications and consequences

Adhesive process, like any pathology, left untreated can cause serious consequences and complications. Most often, patients face the following problems:

• Acute intestinal obstruction.
• Respiratory failure.
• Inflammatory and infectious pathologies.
• Obstruction of the fallopian tubes.
• Infertility.
• Peritonitis.
• Tissue necrosis.
• Uterine retroversion.
• Chronic pain.

Regardless of the severity of complications, the adhesive process requires surgical treatment and a range of preventive measures.

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Diagnostics post-op adhesions

If a postoperative adhesion process is suspected, the patient is prescribed a set of various examinations. Diagnostics of adhesions after surgery consists of:

• Collection of anamnesis and visual examination.
• Analysis of patient complaints.
• A set of laboratory tests (blood, urine).
• Instrumental diagnostics (ultrasound, MRI, CT, radiography, laparoscopy).

The results of a comprehensive medical examination allow us to determine the presence of cords, their location, thickness and even shape. Assess the functioning of internal organs and identify existing disorders. Based on the results of the diagnostics, a treatment plan is drawn up.

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Tests

Laboratory diagnostics of the adhesion process is necessary to determine the extent of its impact on the body. Tests are usually prescribed based on clinical symptoms. Most often, patients complain of pain of various localizations and intestinal disorders.

To diagnose a painful condition, it is necessary to take the following tests:

1. A complete blood count is a standard test that is prescribed to all patients, regardless of the suspected disease. It determines the general condition of the body and allows conclusions to be drawn about the functioning of all its organs and systems. In case of adhesive disease, the following deviations may be present in the blood:

• Leukocytosis – an elevated level of leukocytes indicates an inflammatory process. Moreover, the more band cells, the more intense the inflammation.
• Anemia - a decrease in the number of red blood cells occurs with bleeding in the body. With postoperative cords, this is a rare deviation that can be associated with increased physical activity and rupture of adhesions. This condition requires treatment, since a low level of red blood cells reduces the protective properties of the immune system.

2. Biochemical blood test – reflects the work of internal organs, especially the liver and kidneys. In a pathological condition, the following disorders are possible:

• Increased urea level – occurs due to urinary retention. This is observed when the walls of the bladder or ureter are deformed by strands. Indicates the involvement of the urinary tract in the adhesion process.
• Low hemoglobin – contained in red blood cells, therefore it may indicate internal bleeding.
• C-reactive protein – indicates the acute phase of inflammation.

A stool test may also be prescribed, which is carried out if intestinal obstruction caused by adhesions is suspected. In case of concomitant infertility, a blood test for hormones and a semen analysis are indicated, which will determine reproductive dysfunctions and whether connective tissue adhesions are associated with this.

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Instrumental diagnostics

Another method for detecting adhesions is instrumental diagnostics. If adhesions are suspected after surgery, the patient should undergo the following examinations:

• Ultrasound – ultrasound examination of internal organs visually determines connective tissue adhesions.
• CT – computer tomography allows not only to study the pathological process, but also the factors that provoked it. It is one of the most effective diagnostic methods.
• X-ray with contrast agent - before the procedure, you need to drink a glass of barium salt on an empty stomach. The X-ray images will show intestinal disorders and other complications that cause pain.
• Laparoscopy – to perform this diagnostic method, a small puncture is made in the abdominal cavity and a fiber-optic tube with a camera is inserted. The device fixes adhesions and allows them to be cut out.

Based on the results of instrumental diagnostics, the doctor can prescribe the necessary treatment or additional examinations.

Differential diagnosis

In its symptoms, the adhesive process is similar to many diseases. Differential diagnostics allows us to identify connective tissue adhesions and separate them from other pathologies. Since postoperative pain syndrome and the presence of scars do not always indicate strands. At the same time, adhesions can simulate kidney damage, peptic ulcer, respiratory failure, pancreatitis, cholecystitis, lumbago.

Let's consider the differential diagnostic signs of abdominal adhesions and other diseases of internal organs:

• Strangulated hernia – the presence of a hernial protrusion, pain and tension in the affected area.
• Acute pancreatitis or cholecystitis – intense pain in the right hypochondrium or of a girdle-like nature. Increased body temperature, severe nausea and vomiting.
• Ulcerative lesion of the stomach or duodenum - acute paroxysmal abdominal pain, which intensifies with the slightest movement. X-ray examination reveals free gas in the peritoneum.
• Acute appendicitis – pain in the right iliac region, which intensifies with movement. Elevated body temperature and elevated white blood cell count.
• Torsion of an ovarian cyst – paroxysmal pain in the lower abdomen. When attempting to palpate the abdomen, a volumetric neoplasm is determined.

The differentiation process is carried out at the first suspicion of postoperative adhesions. For this purpose, laboratory and instrumental diagnostic methods are used.

Treatment post-op adhesions

The method of treating adhesions after surgery depends on the general condition of the patient. Since the main reason for the formation of bands is surgical intervention, the treatment should be as gentle as possible, preferably therapeutic. Surgical removal of neoplasms is carried out only in extreme cases when there is a threat to the patient's life.

At the early stages of the adhesion process, vitamin E, folic acid and aloe preparations are used. Such means prevent the formation of new adhesions and make the existing ones more elastic.

In acute cases of the pathology, laparoscopy is indicated. With its help, the cords are dissected, which allows the normal functioning of the affected organs to be restored. Particular attention is paid to physiotherapy and therapeutic nutrition, which alleviate the patient's painful condition.

Medicines

Treatment of postoperative connective tissue adhesions is carried out both surgically and more conservatively, i.e., by medication. Anti-adhesion medications are divided into:

• Fibrinolytic agents – these drugs contain substances that dissolve fibrin, around tissue adhesion. Fibrinolysin, Urokinase, Hyaluronidase, Chemotrypsin, Streptokinase, Trypsin, as well as tissue plasminogen activators.
• Anticoagulants – prevent blood clotting. Drugs from the Citrate and Oxalate group, Heparin.
• Antibacterial and anti-inflammatory agents – prevent the development of infectious and inflammatory complications. Most often, patients are prescribed drugs from the tetracycline group, cephalosporins, sulfonamides, NSAIDs, antihistamines or corticosteroids.

Let's look at the most effective drugs prescribed to patients with postoperative cords of any localization:

1. Streptokinase

Fibrinolytic agent that dissolves blood clots. Affects the enzyme system and dissolves fibrin in blood clots.

• Indications for use: pulmonary artery occlusion and its branches, thrombosis, retinal vascular occlusion, acute myocardial infarction within the first 10-12 hours, formation of cords on internal organs.
• Method of administration: the drug is administered intravenously by drip, in rare cases intra-arterially. The initial dosage is 250,000 IU (IU) dissolved in 50 ml of isotonic sodium chloride solution. In case of severe adhesions, the medication must be administered over a long period of time.
• Side effects: headaches, nausea, chills, allergic reactions, non-specific reactions to protein.
• Contraindications: increased bleeding, recent bleeding, gastric ulcer, microbial diseases, pregnancy, diabetes, severe kidney and liver disease, active tuberculosis, hypertension.

1. Chemotrypsin

Local application of this drug breaks down necrotic tissue and fibrinous formations, helps to liquefy viscous secretions, exudates and blood clots. Contains the active component - chymotrypsin.

• Indications for use: thrombophlebitis, inflammatory-dystrophic form of periodontosis, otitis, tracheitis. Used in physiotherapy procedures for the treatment of adhesions.
• Method of administration: intramuscularly 0.0025 g once a day. For injection, the drug is dissolved in an isotonic solution of sodium chloride. The solution is injected deep into the buttocks. The course of treatment is 6-15 injections.
• Side effects: burning at the site of application, allergic reactions, bleeding from healing areas.
• Contraindications: individual intolerance to active components, intravenous administration, bleeding wounds, malignant neoplasms.

3. Hyaluronidase (Lidase)

An enzymatic agent used to eliminate joint contractures, soften scar tissue and treat hematomas. Contains hyaluronic acid.

• Indications for use: cicatricial changes of the skin of various origins, hematomas, joint contractures, long-term non-healing ulcers, scleroderma, traumatic lesions of the nerve plexuses, rheumatoid arthritis.
• Method of application: the drug is administered subcutaneously under scar-altered tissues, intramuscularly, using electrophoresis, applications to mucous membranes. In ophthalmic practice, the drug is used subconjunctivally and retrobulbarly. The course of therapy is individual for each patient and depends on the severity of the pathological process.
• Side effects: skin allergic reactions.
• Contraindications: malignant neoplasms.
• Overdose: In rare cases, skin allergic reactions may occur.

4. Urokinase

Fibrinolytic, dissolves blood clots by activating plasminogen.

• Indications for use: thromboembolic occlusive vascular diseases, local thrombosis, coronary thrombosis, bleeding in the anterior chamber of the eye and vitreous body, local treatment of adhesions.
• Method of administration: average dose 1000-2000 IU/kg/hour, duration of therapy is determined by the attending physician.
• Side effects: shock, changes in liver function tests, nausea and vomiting, loss of appetite, increased body temperature, headaches, deterioration of general health, allergic skin reactions.
• Contraindications: hemorrhagic stroke, bleeding, recent biopsy, arterial hypertension, recent surgery, severe renal or hepatic insufficiency, pregnancy.

5. Fibrinolysin

Affects the blood system and fibrinolysis. Very often used in combination with Heparin. Its activity is based on the body's natural anticoagulant system and the ability to dissolve fibrin threads.

• Indications for use: vascular occlusion by a blood clot of peripheral or pulmonary arteries, recent myocardial infarction, acute thrombophlebitis.
• Method of administration: intravenously (drip) with isotonic sodium chloride solution, locally.
• Side effects: increased body temperature, pain at the site of application, allergic reactions, chills.
• Contraindications: increased bleeding, gastric ulcer and duodenal ulcer, tuberculosis, radiation sickness, low fibrinogen levels in the blood.

If the adhesion process is accompanied by severe pain, then Paracetamol, No-shpa or Spazmalgon are used to eliminate them. When using anti-adhesion drugs locally, electrophoresis, applications and other physiotherapy procedures are performed.

Ointments for adhesions after surgery

For the resorption of connective tissue adhesions and scars, topical preparations, i.e. ointments, are widely used. The following remedies are effective against adhesions after surgery:

1. Vishnevsky ointment

An antiseptic containing castor oil, xeroform and tar. Widely used to treat inflammation caused by abscesses or furuncles. Restores tissue from burns, bedsores and frostbite, used in gynecology. Promotes softening of postoperative scars and adhesions.

The ointment is evenly distributed over gauze and applied to the affected areas. The dressings are changed 2-3 times a day. The weak irritating effect on tissue receptors accelerates the regeneration process. Long-term use of the product may cause allergic reactions and skin irritation. The main contraindication is kidney disease.

2. Ointment Ziel-T

Homeopathic chondroprotective agent of a wide spectrum of action. It has protective, anti-inflammatory and analgesic properties. Contains active plant components that reduce swelling, have a therapeutic effect on cartilage, bone and soft tissues. The drug is effective in the treatment of postoperative adhesions and scars.

The composition of the drug includes chondroitin sulfate (a structural element of cartilage tissue), sius-organ components that slow down degenerative changes in cartilage tissue, improve microcirculation and promote the enhancement of plastic processes and biocatalysts of oxidation-reduction reactions of the body.

• Indications for use: various diseases of the musculoskeletal system (osteochondrosis, tendinopathy, spondyloarthrosis, deforming osteoarthrosis), injuries and surgeries that resulted in adhesions and contractures.
• Directions for use: apply a small amount of ointment to the affected area 2-5 times a day. The product can be used during massage and various physiotherapeutic procedures.
• Side effects: allergic reactions, skin itching, rash. Overdose symptoms have not been recorded. The ointment is contraindicated in case of individual intolerance to its components.

3. Heparin ointment

Reduces inflammation, prevents blood clotting, dilates superficial vessels, and relieves pain.

• Indications for use: thrombophlebitis of the extremities, phlebitis, thrombosis of hemorrhoidal veins, ulcers of the extremities, postoperative cords.
• Directions for use: apply the ointment to the affected area of skin 2-3 times a day. The product can be used under a gauze bandage during massage.
• Contraindications: ulcerative-necrotic processes, decreased blood clotting, thrombopenia.

4. Hydrocortisone ointment

Inflammatory and allergic skin lesions of non-microbial etiology, allergic and contact dermatitis, eczema, neurodermatitis, resorption of postoperative scars and cords. The product is applied to the skin in a thin layer 2-3 times a day. The ointment is contraindicated in infectious skin diseases, pyoderma, mycoses, ulcerative lesions and wounds.

Gels for adhesions after surgery

In addition to the ointment, a gel can be used to treat the adhesion process. This dosage form does not contain fats and oils, is viscous and soft in composition and consistency. The gel is 70% thickeners and water, so its active components quickly penetrate the wound surface.

Let's look at popular gels for adhesions after surgery:

1. Traumeel gel

A complex homotoxic agent with regenerating, analgesic, anti-inflammatory and anti-exudative properties. Quickly relieves swelling and stops bleeding. Increases vascular tone and reduces their permeability.

• Indications for use: inflammatory processes of the musculoskeletal system, bruises, injuries, sprains, fractures, severe pain syndrome, prevention of postoperative complications, including adhesive disease, purulent-inflammatory diseases.
• The gel is applied in a thin layer to the affected area of the skin 2-3 times a day; the product can be used under a bandage.
• Side effects are manifested in the form of local allergic reactions, itching and redness. The main contraindication is intolerance to the components of the drug.

2. Intercat

Gel used in laparotomic and laparoscopic operations in gynecology and surgery to reduce the amount of postoperative strands. The absorbent is a compound of polyethylene oxide and sodium carboxymethylcellulose.

• Indications for use: open and closed operations in the abdominal cavity and on the pelvic organs. The medicine is released in a special syringe, which makes the process of its use easier. It is easy to apply and dissolves connective tissue adhesions within four weeks.
• Contraindications: infectious processes or complications.

3. Contractubex

Antiproliferative, anti-inflammatory, softening and smoothing scar tissue preparation. Contains the active substance - onion extract, which reduces the release of anti-inflammatory mediators in the area of application and allergic reactions. Reduces the growth of fibroblast cells, has bactericidal properties. The gel also contains heparin and allantoin, which accelerate the healing process, improve tissue permeability, and slow down collagen synthesis.

• Indications for use: postoperative and post-traumatic scars and cords, Dupuytren's contracture, keloids, traumatic contractures.
• Directions for use: apply a small amount of gel to the postoperative scar and rub in until completely absorbed. The product can be used under a bandage.
• Side effects are manifested in the form of local allergic reactions. The gel is contraindicated in case of individual intolerance to its components.

4. Mesogel

Anti-adhesive agent based on carboxymethylcellulose polymer. It is used in surgical interventions after which there is a risk of adhesion development. It does not have a general toxic, local irritant or allergenic effect. It is effective in the presence of exudate or blood, is not encapsulated and is not a nutrient medium for pathogenic microorganisms.

The mechanism of action of the gel is based on the separation of damaged surfaces until they are completely healed. The drug creates conditions for normal sliding of organs, reduces the level of fibrin. It is produced in sterile syringes of 5-100 ml and in polymer containers of 200 ml.

• Indications for use: prevention of cord formation during operations on organs and tissues with increased adhesion formation.
• The method of application and dosage depend on the packaging of the medicine and the method of performing the operation. The gel is applied to the tissue areas where cords may form. The product is applied in a thin layer over the surface being treated, thereby creating a reliable coating for the time of tissue healing.
• Contraindications: hypersensitivity to cellulose ethers, any disease at the stage of decompensation, terminal conditions, kidney and liver diseases, acute stage of purulent peritonitis.

After application, Mesogel gradually dissolves, and its concentration decreases due to an increase in volume and the splitting of its molecules into short fragments. If the product is used in the abdominal cavity, its molecules are absorbed into the capillary network of the peritoneum, penetrate into the lymphatic system through the serous membrane of the intestine. Most of the drug is excreted in the urine, and the rest is broken down into glucose, water and carbon dioxide.

Suppositories against adhesions after surgery

For the prevention and treatment of connective tissue adhesions after surgery (especially during gynecological or urological manipulations), suppositories against adhesions are recommended. After surgery, the following medications can be used:

1. Ichthyol suppositories

They have antiseptic, anti-inflammatory and local anesthetic properties. They are used for neuralgia, inflammatory pathologies of the pelvic organs, after recent surgeries. Suppositories should be administered after a cleansing enema, the duration of therapy and frequency of use are determined by the attending physician.

2. Longidaza

Suppositories for vaginal or rectal use. The drug is a macromolecular complex of the proteolytic enzyme hyaluronidase with a high-molecular carrier. It has pronounced anti-edematous, anti-inflammatory, immunomodulatory, antioxidant properties. Increases tissue permeability and trophism, resolves hematomas, increases the elasticity of cicatricial changes. Reduces and completely eliminates adhesions and contractures, improves joint mobility.

• Indications for use: diseases accompanied by the proliferation of connective tissue. Most often prescribed in urological and gynecological practice, in surgery, cosmetology, pulmonology and phthisiology, after surgical interventions in the abdominal cavity and long-term non-healing wounds.
• Method of administration: suppositories are administered rectally after bowel cleansing, 1 suppository once every 48 hours, or vaginally, 1 piece every three days. The duration of therapy is determined by the attending physician. If necessary, a repeated course of treatment may be prescribed, but not earlier than 3 months after the end of the previous one.
• Side effects: systemic or local allergic reactions.
• Contraindications: intolerance to active components, severe renal dysfunction, malignant neoplasms, patients under 12 years of age. With special caution it is prescribed for patients with renal failure, recent bleeding, in acute infectious diseases.

In addition to the suppositories described above, you can use tampons with various ointments, for example, with heparin or Vishnevsky ointment.

Vitamins

For the treatment and prevention of adhesions after surgery, patients are recommended to take vitamins. Tocopherol (vitamin E) and folic acid (vitamin B9) have proven themselves to be effective in combating strands.

1. Tocopherol

Vitamin E is an active antioxidant that protects various substances from oxidation, such as retinol or polyunsaturated fatty acids. The natural antioxidant is involved in protein biosynthesis, tissue respiration, and important processes of cellular metabolism. Its deficiency leads to degenerative changes in nerve cells and damage to the tissues of internal organs, especially the liver parenchyma.

• Indications for use: muscular dystrophies, diseases of the central nervous system, dermatoses, spasms of peripheral vessels, various disorders of motor activity, complex treatment of cardiovascular and ophthalmological diseases.
• The method of administration and dosage depend on the form of the drug, indications for use and the individual characteristics of the patient's body.
• Side effects: high doses of the vitamin cause gastrointestinal disorders, decreased performance and creatinuria.
• Contraindications: destructive changes in the heart muscle, myocardial infarction, high risk of thromboembolism.

Vitamin E deficiency may be associated with a decrease in red blood cells. The vitamin is available in several forms: vials, oil solution, capsules for oral administration, ampoules for intravenous or intramuscular administration.

2. Folic acid

Belongs to the group of B vitamins. Enters the body with food and is synthesized by intestinal microflora. Participates in important metabolic processes in the body, is necessary for choline metabolism. Stimulates blood formation processes. Has a tablet form of release.

After oral administration, it is completely absorbed in the duodenum and proximal parts of the small intestine. About 98% of the dose taken penetrates into the blood within 3-6 hours. Metabolizes in the liver, 50% is excreted in the urine, the rest in the feces.

• Indications for use: hyperchromic macrocytic and megaloblastic anemia, normalization of erythropoiesis, anemia and leukopenia, pellagra, pernicious anemia, postoperative conditions, improvement of the epidermis.
• Directions for use: Tablets are recommended to be taken orally after meals. Typically, 3-5 capsules per day. The course of treatment is 20-30 days.
• Side effects: in rare cases, allergic reactions occur, which are relieved with antiallergic medications.
• The main contraindication is individual intolerance to folic acid. No cases of overdose have been recorded.

To speed up recovery and minimize the risk of adhesions, vitamins should be taken daily. Particular attention should be paid to a balanced diet with the necessary micro and macro elements, minerals and, of course, vitamins.

Physiotherapy treatment

One of the effective methods for eliminating postoperative adhesions is considered to be physiotherapy. Most often, such therapy is prescribed for adhesions in the pelvic organs.

The main goal of physiotherapy procedures:

• Activation of tissue metabolism – physiotherapy improves blood circulation and metabolism in the affected tissues. This helps prevent compression and twisting of organs.
• Softening of connective tissue – due to the impact of physical factors on connective tissue, it becomes more elastic. This helps to minimize pain and the risk of developing intestinal obstruction or obstruction of the fallopian tubes.

The most noticeable effect is possible in the first months of the disease, when the cords are not too hard and strong. Treatment prevents their strengthening and prevents the growth of new tissue. In the adhesion process, the following methods are used:

• Ozokerite and paraffin applications.
• Electrophoresis with absorbable and analgesic drugs.
• Laser or magnetic therapy.
• Electrical stimulation.
• Ultrasound and massage.
• Hirudotherapy.

Let's take a closer look at the most effective physiotherapy procedures:

1. Ozokerite and paraffin applications are aimed at warming up the pelvic organs. Their effect is similar to laser therapy and ultrasound. They increase local immunity, stimulate blood circulation and lymph flow. Applications are contraindicated in case of inflammatory lesions of the pelvis and skin diseases.
2. Ultrasound is a method of influencing organs and tissues using ultrasonic waves. Accelerates metabolic processes at the molecular level. Helps destroy pathogenic microorganisms in chronic foci of infection. Destroys the microstructure of adhesions, increases their elasticity.
3. Laser therapy – heating of the affected tissues to stimulate blood circulation and prevent the formation of collagen protein (the basis of adhesions and scar tissues). This method is especially effective in the early stages of the pathological process.
4. Electrical stimulation – based on sending electrical impulses using a special device to the affected tissues. Stimulates blood circulation and lymph flow, enhances regeneration processes, and minimizes pain.
5. Electrophoresis – this procedure consists of hardware and drug exposure. With the help of an electric field, drugs containing the enzyme hyaluronidase (Lidase, Longidaza, and others) are introduced into the body. Electrophoresis is especially effective in the first months after surgery, as it prevents the formation of cords. With its help, it is possible to restore the functioning of organs even with advanced connective tissue formations. The technique is absolutely painless, but has a number of contraindications: severe intoxication, blood diseases, oncology, cachexia, cardiac arrhythmia, intolerance to the drugs used.
6. Treatment with leeches (hirudotherapy) - the effectiveness of this method is based on the enzyme hyaluronidase, which is part of the leeches. It softens the adhesions and makes them permeable to drugs, reduces their size. As a result of such treatment, the mobility of organs is restored, and painful sensations are reduced. Leeches are placed on problem areas for 30-40 minutes. There should be no wounds or other damage on the skin. As a rule, patients are prescribed 7-10 sessions. This method has no contraindications and side effects.

Physiotherapeutic treatment is also carried out in advanced adhesive processes that have led to organ deformation and the appearance of acute pathological symptoms. Such therapy allows to minimize painful sensations and improve the patient's condition.

Folk remedies

In addition to drug and surgical therapy of postoperative cords, folk remedies are often used to eliminate them. Alternative therapy helps prevent the growth of neoplasms. Let's look at popular folk recipes:

• Take 50 g of flax seeds, wrap them in a piece of gauze and dip them in 500 ml of boiling water for 5-10 minutes. Cool and apply to the sore spot for 1-2 hours 2-3 times a day.
• Pour 250 ml of boiling water over a tablespoon of dry St. John's wort and simmer for 10-15 minutes. Strain the resulting decoction and take ¼ cup 3 times a day.
• Take two parts of rose hips and nettle, mix with one part of lingonberry. Pour 250 ml of boiling water over the resulting mixture and let it brew for 2-3 hours. Take ½ glass twice a day.
• Take equal parts of sweet clover, centaury and coltsfoot. Pour 250 ml of boiling water and let it brew for 1.5 hours. Take ¼ cup 3-5 times a day.
• Black cumin oil, which can be purchased at a pharmacy, has medicinal properties. It contains phytosterols, tannins, carotenoids and fatty acids. It has antibacterial, regenerating and anti-inflammatory effects. The oil can be used to soak tampons, for douching, for external or internal use.

Folk treatment of adhesions after surgery should be carried out only after consultation with the attending physician and only if the pathological process is mild.

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Herbal treatment

Another option for folk treatment of adhesions is herbal treatment. Let's look at popular herbal recipes:

• Grind three tablespoons of bergenia roots and pour 300 ml of water over them. The remedy should be infused for 3-4 hours, preferably in a thermos or tightly sealed container. Strain and take 2-3 teaspoons an hour before meals. The course of treatment is three days, after which you need to take a break of 2-3 days and then continue the therapy again.
• Take aloe (not younger than 3 years), cut a couple of leaves and put them in a cold place for 48 hours. Grind, add 5 spoons of honey and 50 ml of milk. Mix all ingredients well and take 1 tablespoon 3 times a day.
• Pour 200 ml of boiling water over a tablespoon of milk thistle seeds and boil for 10 minutes. After cooling, strain the decoction and take 15 ml 3 times a day.
• Pour 1 liter of vodka over 50 g of crushed Peony root and let it brew for 10 days in a dark place. The infusion should be taken 40 drops for a month 2-3 times a day before meals. After this, you need to take a break for 10 days and repeat the treatment again.

Herbal treatment should be carried out with extreme caution and only after medical permission. Particular attention should be paid to the proportions of medicinal components.

Homeopathy

For the treatment of cords of different localizations, not only traditional medicine is used, but also alternative methods. Homeopathy is one of the latter. In the postoperative adhesion process, the following drugs are recommended:

• Arsenicum album – painful growths after injuries.
• Calcarea fluorica – cords after operations, deep wounds and various injuries.
• Cundurango – adhesions and ulcerations in the oral cavity.
• Dulcamara, Euphrasia, Plumbum, Rhus toxicodendron, Thuja – proliferation of connective tissue in the nose.
• Ranunculus bulbosus – cords after pleurisy.
• Silicea – used for healing after operations, injuries and wounds. Stimulates the body to accelerate the resorption of fibrous formations and scar tissue.

Homeopathic medicines can only be taken as prescribed by a homeopathic physician, who selects the medicine (dosage, course of treatment) individually for each patient.

Surgical treatment

If the adhesive process is in an advanced or acute state, causing pathological symptoms from the internal organs, then surgical treatment is indicated. The main goal of such therapy is the mechanical removal of inclusions that disrupt blood supply, interfere with the normal functioning of the gastrointestinal tract and other organs.

Surgical treatment can be performed using the following methods: laparoscopy and laparotomy. In this case, the fact that abdominal surgery can cause new connective tissue adhesions is taken into account. Therefore, when choosing a method, preference is given to the less traumatic one.

1. Laparoscopy

Refers to low-trauma surgeries. Through a puncture in the abdominal cavity, the doctor inserts a fiber-optic tube with a miniature camera and lighting. Surgical instruments are inserted through additional incisions, with the help of which adhesions are dissected and blood vessels are cauterized. Dissection can be performed using an electric knife, laser or hydraulic pressure. After such an operation, recovery is quick and with minimal complications. But there is still no guarantee that a relapse will not occur.

2. Laparotomy

Prescribed for a large number of adhesions. The operation is performed through an incision (10-15 cm) in the anterior abdominal wall to obtain extensive access to the internal organs. The method is traumatic, recovery is long with a mandatory course of anti-adhesive physiotherapy.

When choosing the tactics of surgical treatment, many factors are taken into account. First of all, it is the patient's age. Elderly patients undergo only laparoscopy. Another factor is the presence of concomitant pathologies and general health. If the patient has serious diseases of the cardiovascular or respiratory system, this is a contraindication to surgery.

Special attention should be paid to the postoperative period. It is necessary to provide the intestines with functional rest until the wounds are completely healed. To do this, you should refuse food in the first days after the operation and take only liquids. On the second or third day, you can gradually take liquid dietary food (broths, mashed porridge, vegetable purees). As the condition improves, that is, after about 7-10 days, you can gradually restore the diet.

After the operation, it is strictly forbidden to drink alcohol, strong coffee and tea, confectionery, spicy, salty, fatty or fried foods. Following a diet allows you to quickly recover after treatment and prevent the appearance of new cords.

Removal of adhesions after abdominal surgeries

Many patients develop scars, i.e. bands, after surgical interventions or long-term inflammatory processes. Such adhesions disrupt the functioning of internal organs and cause acute pain. This is the main indication for the removal of adhesions. After abdominal operations, the laparoscopic method is most often used.

If the pathological process is advanced, then laparotomy is performed. This method has the following indications:

• Proliferation of connective tissue throughout the abdominal cavity.
• The appearance of purulent formations in the intestines.
• Severe intestinal obstruction.
• Acute inflammatory process in the abdominal cavity.

During laparotomy, access to internal organs is achieved through an incision in the abdominal wall, i.e. as in a full abdominal operation. During laparoscopy, several small incisions are made through which equipment is inserted. In both cases, the operation lasts about 1-2 hours. The patient will have a long recovery period and a set of preventive measures.

Exercises against adhesions after surgery

One of the methods of preventing adhesions is therapeutic gymnastics. Exercises against adhesions after surgery are aimed at activating local blood supply to the affected tissues and internal muscle fibers, increasing their elasticity.

Let's look at an approximate set of anti-adhesive exercises:

• Sit on the floor and stretch your legs straight. Bend them at the knees and pull them to your chest, slowly straightening them to the starting position.
• Lie down on the floor, put your hands behind your head, bend your knees and rest on the floor. Slowly lift your shoulder blades.
• Lying on the floor, bend your knees, press your shoulder blades to the floor, stretch your arms along your body. Gradually raise your pelvis, lowering your knees to your chest, and return to the starting position.
• Lie down on the floor, place your hands under your buttocks, straighten your legs and lift them up. Make crossing movements with your legs (scissors). Another variation of this exercise is the bicycle, in which case the movements should be large in amplitude and directed toward the abdomen and chest.

Yoga, which is based on abdominal breathing, has healing properties. Gymnastics in combination with proper nutrition speeds up the recovery process and alleviates painful symptoms.

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Prevention

Methods of preventing adhesions are based on reducing tissue damage during various surgical interventions. Prevention consists of protecting the abdominal cavity from foreign objects (dressing material) and careful sanitation of the surgical field. It is also very important to minimize the risk of postoperative bleeding.

To prevent adhesions, patients are prescribed antibacterial and anti-inflammatory drugs, as well as fibrinolytics, anticoagulants, and proteolytic enzymes. Particular attention is paid to therapeutic exercises and physiotherapy with medications (electrophoresis with Lidase).

Nutrition is important for both preventive and restorative purposes. Let's look at the main dietary recommendations:

• You should not starve or overeat, as this aggravates the pathological condition and can cause complications.
• It is necessary to follow the regime of meals at certain times. Meals should be fractional, you need to eat small portions 4-6 times a day.
• Heavy and fatty foods, foods with high fiber content and those causing flatulence (legumes, cabbage, radish, turnip, radish, grapes, corn) should be excluded from the diet. Carbonated and alcoholic drinks, hot spices and sauces, whole milk are prohibited.
• The menu should include food rich in calcium, i.e. cottage cheese, cheese, fermented milk products. They promote intestinal peristalsis. At the same time, the food should be at room temperature, since too cold or hot can cause spasms.
• Patients should consume low-fat broths, steamed, boiled or baked lean meats and fish. You can eat greens, vegetables and fruits. However, you should avoid marinades and smoked foods.

To prevent the development of adhesions, constipation should be treated in a timely manner, food poisoning and inflammatory processes should be avoided. It is necessary to lead an active lifestyle, but avoid heavy physical exertion. The above recommendations minimize the risk of developing pathology.

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Forecast

Single adhesions after surgery have a favorable prognosis, while multiple lesions cause a number of serious and even life-threatening complications. To prevent bands, it is necessary to lead a healthy lifestyle, follow a therapeutic diet and all medical recommendations. Also, do not forget that the appearance of connective tissue adhesions largely depends on medical competence, compliance with the technique and rules of the operation, adequate postoperative recovery.

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