Adhesion of the intestine and small pelvis after the operation: from what to appear and what to treat

Thin films of connective tissue between internal organs are spikes. After surgery, they occur most often. Consider the features of their appearance and treatment.

The internal organs of man are covered from the outside with a thin shell that separates them from each other. A small amount of fluid and the smoothness of the tissues ensure the displaceability of the organs during movements.

Normally, after the operation, the internal organ is scarred, and the period of its healing is called the adhesive process. That is, connective tissue fusion (similar to polyethylene film or fibrous bands) is a physiology that passes by itself and does not disrupt the functioning of the body.

With the development of the pathological process, the strands are glued together, disrupting the normal movement and functioning of the organs. After the operation, they are most often diagnosed on such organs:

• Appendicitis and intestinal lesions - lead to obstruction of the organ and require additional surgical treatment.
• Education in a small pelvis - can significantly disrupt women's health and the possibility of conceiving a child.
• Inclusions in the ovaries or tubes - are due to inflammation of the appendages or infectious lesions, can lead to infertility.
• Without timely diagnosis and treatment, it threatens with serious complications and severe pain.

What are the dangerous spikes after the operation?

Very often patients ask the question, what are the dangerous spikes after the operation. So, if the cords appeared in the abdominal cavity, for example, in the narrow 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 development of bleeding.

Connective tissue inclusions in the peritoneum are dangerous because they can cause intestinal obstruction and intestinal obturation. Neoplasms flex and stretch certain parts of the intestines or organs, disturbing their work. At the same time, a life-threatening condition is complete intestinal obstruction.

The proliferation of connective tissue on the respiratory organs causes respiratory and cardiovascular insufficiency. Because of the violation of local blood supply, tissue necrosis and the development of peritonitis are possible. A lot of dangerous formations on the organs of the small pelvis. So, 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 in 98% of cases is associated with surgical intervention. Adhesion disease is more common in women (after appendectomy and operations on the uterus and appendages) than men (injuries of the abdominal cavity).

• After surgery on the organs of the abdominal cavity, 80-85% of patients develop splices on the narrow and large intestine.
• Multiple laparotomy leads to the formation of adhesions in 93-96% of patients.
• After appendicitis, intestinal adhesions a year later appear in 23% of operated and in three years in 57%.
• After gynecological pathologies, in 70% of cases the cords appear on the uterus and ovaries.

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

[1], [2], [3], [4], [5], [6]

Causes of the adhesions after surgery

There are a number of factors that affect the proliferation of connective tissue of internal organs. The reasons for the formation of adhesions after surgery largely depend on the professionalism of the surgeon. Most pathological condition occurs when:

• Inflammatory and infectious complications.
• Bleeding in the abdominal cavity.
• Injuries to the stomach and pelvic organs.
• Prolonged ischemia of tissues.
• Foreign objects in the wound.
• Violations of the operation technique.

The adhesion process can be provoked by the patient himself, because of the failure of the doctor's recommendations for recovery after surgery. The pains are formed after appendicitis, ectopic pregnancy or abortion, with intestinal obstruction, endometriosis and ulcerative lesions of the stomach.

Proceeding from this, it can be concluded that postoperative inclusions are formed for a variety of reasons. Without timely diagnosis and treatment, they complicate the functioning of internal organs, which leads to various complications.

[7], [8], [9], [10]

Risk factors

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

1. Gravel in the abdominal cavity can be formed with bruises and abdominal injuries. Hemorrhages in the retroperitoneal space and hematomas in the mesentery lead to lymphostasis and a violation of the outflow of blood. In turn, this leads to a violation of exudation in the abdominal cavity. As a result, the internal organs remain without natural lubrication, begin to rub against each other and to weld.
2. Abdominal obesity - excess fatty tissue in the area of the huge omentum, that is, the folds behind the visceral leaf of the peritoneum and the lining of the intestinal loop, can provoke connective tissue fusion. Loose gland tissue is particularly sensitive to the formation of strands due to the pressure of fat deposits in the abdomen.
3. Disturbances can occur in inflammatory processes. For example, with chronic cholecystitis, spikes appear not only on the gallbladder, but also on the liver, stomach, duodenum, omentum. Most often, this is observed after the flu, dysentery or Botkin's disease.
4. Another risk factor is the congenital malformations of the abdominal organs. As a rule, splices are diagnosed in the iliac and cecum areas.
5. Some chemicals contribute to the formation of strands. 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, a huge risk of adhesion is after laparotomy. Any operation on the abdominal organs is associated with a mechanical trauma to the peritoneum. At the same time, the rougher the surgeon works, the higher the risk of pathological fusion. The disorder occurs due to a violation of the fibrinolytic system of the body.

[11], [12], [13]

Pathogenesis

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

The permeability of blood vessels gradually increases, and the damaged tissues produce serous-hemorrhagic exudate (contains leukocytes, platelets, interleukins, macrophages, fibrinogen, hyaluronic acid, proteoglycans). Under normal conditions fibrin is lysed, but because of the operation fibrinolytic activity decreases, and excess fibrinogen is transformed into a kind of gel that covers the affected tissue. Gradually, fibroblasts expand and fasten together, transforming into internal scars, that is, spikes.

[14], [15], [16]

Symptoms of the adhesions after surgery

The duration of the formation of connective tissue fusion directly depends on the affected organ. Symptoms of adhesions after surgery are most often manifested by painful sensations in the area of an operation scar.

The most common symptoms of a postoperative disorder:

• Nausea and vomiting.
• Violation of defecation.
• Lack of a chair.
• Regular constipation.
• Painful sensations during palpation of the surgical suture.
• Increase body temperature.
• Difficulty breathing and shortness of breath.
• Redness and swelling of the outer scar.

Initially, pain symptoms are absent, but as the scar becomes thicker, they acquire a pulling character. Discomfort increases with physical exertion and any movements. For example, after surgery on the liver, lungs or pericardium, pain occurs with a deep sigh. If the adhesions are formed on the organs of the small pelvis, then pain during sexual intercourse is possible. The clinical picture depends on the location of the cords and the general condition of the body.

[17], [18],

First signs

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

The pathological condition is accompanied by attacks of nausea and vomiting. Possible bloating and frequent constipation. Paroxysmal pains are weakened and renewed. Because of this, the patient becomes irritable, changes in body weight due to lack of appetite. As the disease progresses, there are disorders from the cardiovascular and respiratory systems.

[19], [20], [21]

Pain after adhesion to adhesions

Symptoms such as pain associated with adhesions after surgery occur in many patients. Discomfort is paroxysmal and cutting. At the same time taking antispasmodics and pain medications does not give positive dynamics.

Depending on the pain, these forms of adhesions are distinguished:

1. Acute form - spikes cause pain of varying intensity, which leads to a sharp deterioration in health. The temperature rises, breathing develops, the pulse becomes faster. Attempts to palpate the postoperative scar cause severe pain. Against this background may develop intestinal obstruction, renal failure.
2. Chronic form - if the cords have formed in a small pelvis, then the symptomatology of the disease is similar to the premenstrual syndrome. There may be abnormalities in the functioning of the intestine and urinary bladder. Pain appears during sexual intercourse and when the position of the body changes.
3. The intermittent form is characterized by pronounced disturbances in the functioning of the organs of the gastrointestinal tract. Chronic constipation is followed by a disorder of the stomach. Pain occurs less often, but rather intense.

In addition to pain, frequent attacks of nausea and vomiting, anorexia, loss of performance, migraine and dizziness occur.

Bowel adhesions after surgery

The formations from the connective tissue between the loops of the intestines and the organs of the abdominal cavity are the intestinal adhesions. After the operation, they appear most often. Surgical intervention leads to the gluing of the serous membranes of the 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 causes of the appearance of connective tissue fusion of the intestine:

1. Surgical intervention - according to medical statistics, if primary laparotomy was performed on the intestine, inclusions are formed in 14% of patients. If this is 3-4 operations, then soldering occurs in 96% of cases. Pathology is aggravated by infectious and inflammatory processes.
2. Abdominal trauma (open, closed) - very often mechanical damage leads to internal bleeding. On the intestine, hematomas are formed, lymphatic outflow and metabolic processes in the tissues of the organ are disturbed. Inflammation develops, which provokes an adhesion process.

In addition to the above reasons, the disorder can occur due to inflammation of the appendages in women, with congenital anomalies in the development of the organ, foreign bodies in the peritoneum or the taking of certain medications.

There are additional risk factors for adhesions after intestinal surgery:

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

Symptoms of the pathological condition are divided into several stages. The first thing the patient faces is the intestinal obstruction. There are paroxysmal pains in the abdomen, which are supplemented by nausea and profuse vomiting. Perhaps asymmetric bloating. Palpation of the abdominal cavity causes severe pain. Early adhesive obstruction, as a rule, is formed against the background of the inflammatory process. If you leave this state without medical assistance, it will lead to intoxication complications and paresis of the organ.

The diagnosis of postoperative intestinal pathologies is based on characteristic symptoms, visual examination of the patient and collection of anamnesis. To clarify the diagnosis, use survey radiography of the abdominal cavity, electrocardiography, ultrasound and MRI, laparoscopy. During studies it is necessary to differentiate the strands from other types of acute intestinal obstruction or tumor formations. Surgical treatment, with a course of physiotherapy to prevent the proliferation of connective tissue.

[22]

Adhesions after a cavitary operation

With such a pathology as spikes after a cavitary operation, almost every patient is confronted. The proliferation of connective tissue can lead to an adhesive disease, which is accompanied by serious impairment of the functioning of internal organs.

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

• Inflammatory reactions.
• Infectious complications of surgery.
• Counteraction to blood clotting.
• Increased protein in the blood.
• Individual features of the body.

If only one leaflet is injured in the peritoneum of the peritoneum, and the one with which the internal organs contact, then as a rule, splices are not formed. If soldering does appear, it does not lead to a disruption in the function of the organs, since the strands are superficial and easily stratified.

If two adjacent leaflets were injured, then this triggers a series of pathological reactions. Violation of the integrity of the blood capillaries is associated with certain blood proteins, but the clumping of organs with clotting factors and the action of globulins.

Connective tissue fusion is small in size, but can lead to deformation of the structure of the organs. The clinical signs of the disease depend on the location and size of the adhesions. Most often, patients face such problems: abdominal pain, deterioration in overall well-being, constipation, nausea and vomiting. Painful sensations arise because of a disruption in the functioning of the intestine, and, as a rule, they have a paroxysmal character. For the diagnosis of the disease, an anamnesis is collected and the patient is examined. Treatment is surgical.

[23], [24], [25]

Spikes after an operation to remove the uterus

Seals from the connective tissue that arise during surgical procedures and inflammatory processes are spikes. After surgery to remove the uterus, they occur in 90% of women. It's a rather dangerous complication, as they can lead to functional disorders in the work of internal organs and even to severe intestinal obstruction.

Hysterectomy, that is, removal of the uterus, is characterized by the formation of connective tissue scarring in place of incisions and scars. If the physiological process proceeds with complications (infection, inflammation), the fibrous cords continue to expand and germinate into other internal organs.

The main causes of proliferation of connective tissue after removal of the uterus depend on such factors:

• Duration of the operation.
• Volume of surgical intervention.
• The volume of blood loss.
• Endometriosis.
• Genetic predisposition to adhesions.
• Internal bleeding and infection of wounds 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 the wound contains fibers with a tampon or gauze, particles of talc from the surgeon's gloves.

Signs of development of the pathological process are manifested by such symptoms:

• Drawing and aching pain in the lower abdomen. Discomfort is periodic.
• Violations of urination and defecation.
• Dyspeptic disorders.
• A sharp rise in temperature.
• Painful sensations during intercourse.

If after a hysterectomy has passed more than a month, and the above symptoms do not pass, then you should immediately seek medical help. To diagnose the disorder in the postoperative period, I assign the following examinations to the patient:

• Complex of laboratory studies.
• Ultrasound examination of the abdominal cavity and pelvic organs.
• Radiography of the intestine by contrast.
• Laparoscopic diagnosis.

Connective tissue fusion is treated operatively. The dissection and removal of neoplasms is carried out with the help of laser therapy, aquadisection, electrosurgery. In the postoperative period, drug prevention is indicated. The patient is prescribed broad-spectrum antibiotics and anticoagulants. Also appoint physioprocedures with electrophoresis of enzymes, which destroy fibrin.

If you leave the adhesions in the uterus without treatment, it will cause the uterine tube to turn into a connective tissue sac. The organ will lose its ability to promote fertilized ova. In this case, even surgical treatment is not able to restore the function of the fallopian tubes, which is one of the causes of infertility.

Spikes after an operation of appendicitis

One of the most common surgical procedures is the removal of the appendix. Despite the simplicity of the procedure, the patient will have a long recovery period. Spikes after the operation of appendicitis are formed quite often and are one of the complications.

The proliferation of connective tissue is associated with irritation of the internal organs due to mechanical action on them. On the shells that cover the intestine, dense strands are gradually forming. They grow among internal organs, occupying a certain space. The pathological process is accompanied by the defeat of the blood vessels and leads to deformation of the intestine due to the coalescence of its loops among themselves.

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

• Removal of the appendix in the open way, and not with the help of laparoscopy.
• Prolonged inflammatory process after surgery (peritoneal and intestinal tissues are affected by pathogens and their toxins).
• Genetic predisposition to increased activity of certain enzymes that accelerate the process of scarring.
• Development of pathology due to medical error (for example, left in the abdominal cavity napkin).
• Coagulation (with cauterization of blood vessels may form strands) or internal bleeding.

The painful condition is manifested by drawing pains in the area of the postoperative scar and deeper in the abdomen. On this background there are symptoms from the digestive tract: bloating, nausea and vomiting. There is also a decrease in blood pressure and cardiac dysfunction, a general weakness. For the diagnosis of connective tissue fusion, ultrasound examination of the abdominal cavity, collection of anamnesis, a complex of laboratory tests, radiography and diagnostic laparoscopy.

Treatment depends on the results of the diagnosis. The patient is prescribed conservative therapy, which consists of taking medication, observing a diet and physiotherapy procedures. In especially severe cases, surgical treatment is prescribed. The operation is performed using a laser or an electron-knife. The doctor dissects the adhesions, releasing the organs.

If you leave appendicitis cords without medical assistance, then this can lead to serious complications. First of all, it is an intestinal obstruction due to the movement of the organ loops. With damage to the appendages, uterus or patency of the fallopian tubes, infertility may develop. The most dangerous complication is tissue necrosis. Spikes press on the tissues and compress the blood vessels, which leads to a violation of blood circulation. An impromptu site gradually dies.

Spikes in the nose after surgery

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

• Disorders of intrauterine development and genetic pathologies.
• Chemical or thermal burns of the mucosa.
• Infectious diseases.
• Regular nasal bleeding.
• Syphilis.
• Scleroma.

In some patients, the cords do not cause discomfort, since they are soft and thin. But most often patients face such problems:

• Difficult nasal breathing.
• Change of voice.
• Dryness in the throat in the morning.
• Full or partial perception of odors.
• Inflammation of the upper respiratory tract.
• Inflammation in the paranasal sinuses.

Synechia in the nasal cavity is distinguished depending on their location and the tissue from which they are formed. If the growths were formed on the threshold of the nose, then they are anterior, the inclusions between the nasal conchae and the septum are median, and the formations in the khohan region are the rear synechiae. The last type of splice is the most dangerous, since they can completely or partially block the supply of air from the nose to the pharynx.

Also, connective tissue bands are distinguished, which have a soft texture and are easy to dissect. More dense and bony neoplasms, more often act as a sign of congenital pathology and require surgical treatment. To diagnose postoperative adhesions in the nose, you should consult an otolaryngologist. With the help of a rhinoscope, the doctor determines the presence of pathology. It is also necessary to pass a complex of laboratory tests that will allow to identify inflammatory processes and other disorders.

Treatment is carried out only surgically, as neoplasms do not dissolve on their own. For this, a classical operation, that is, removal with a scalpel, laser removal, or a radio wave effect, can be prescribed. Drug therapy is used only to stop the infectious or inflammatory process.

If you leave the pathology without treatment, it can lead to various ENT diseases (pharyngitis, otitis, pneumonia, bronchitis). In addition, inadequate ventilation of the paranasal sinuses is an ideal environment for infection, which can affect the ears and affect hearing quality.

Spikes in the small pelvis after surgery

Connective tissue fusion in the pelvic organs, this is a common pathology among women, which leads to infertility. Spikes in the small pelvis after surgery arise due to tissue trauma and various inflammatory complications. At the same time, the longer and more traumatic the operation, the higher the risk of formation of cords.

The clinical picture of adhesive process has several forms:

• Acute - pain syndrome has an increasing character. Nausea and vomiting, increased body temperature, increased heart rate. When trying to palpate the abdomen there are sharp pains. Also, acute obstruction of the intestine, general weakness and drowsiness, and micturition disorders are possible.
• Intermittent form - pain periodic, there are disorders of the intestines (diarrhea, followed by constipation).
• Chronic - the symptoms of this form are hidden. Pain of aching in the lower abdomen, constipation. Most often, this type of disorder is diagnosed accidentally, during a checkup if there is a suspicion of infertility or endometriosis.

Diagnosis is difficult. When initially seeking medical help, the doctor collects an anamnesis and complaints of the patient. Bimanual examination reveals immobility of organs or their limited displacement. Also carried out ultrasound, MRI, laboratory tests and other examinations.

Treatment of cords after surgery in a small pelvis consists of medical and surgical methods. To remove adhesions and separation of organs apply such methods: laser therapy, aqua dissection, electrosurgery. Conservative therapy is based on the elimination of the inflammatory process. Patients are shown a therapeutic diet, physiotherapy and a set of other activities for normal recovery.

Adhesion after operation of the gallbladder

The formation of strands with cholecystectomy occurs in every third patient. Spikes after the operation of the gallbladder are associated with several factors, consider them:

• Injuries and bruises of the peritoneum, which disrupt the outflow of blood from the tissues lining the surface of the abdominal cavity.
• Aseptic inflammation caused by ingestion of certain substances (alcohol, iodine or rivanol solution) during the operation.
• Inflammatory infiltration in the operative zone.
• Chronic cholecystitis causes cicatricial changes in the gallbladder, which significantly complicates the process of its removal and recovery from surgery.
• Atypical anatomical structure of the organ, its vessels and bile ducts.

The risk factors for the appearance of adhesions include the patient's elderly age, excessive body weight, and the presence of chronic diseases. A painful condition can be associated with blood or an inflammatory fluid that has not resolved after surgery, but thickens and is replaced by a connective tissue.

Symptoms of cords after surgery on the gallbladder are manifested by a decrease in pressure, sharp acute pains, constipation, general weakness and an increase in temperature. If the pathology takes on a chronic form, then there are symptoms: intestinal cramps, bloating, vomiting with a stool, strong thirst, deterioration in overall well-being.

The treatment depends entirely on the patient's physical condition and the course of the adhesion process. As a drug therapy shows the use of anticoagulants, proteolytic enzymes, fibrinolytics. In severe cases, a surgical operation is performed. Particular attention is paid to prevention, which consists of a special diet and physiotherapy procedures.

[26], [27], [28]

Spikes after ovarian surgery

There are a number of reasons for the formation of spikes after surgery on the ovary. The main factor is a long inflammatory process, infection or complications during the operation. Possible causes of the disorder include:

• Erosion of the cervix or a violation of its cauterization.
• Numerous discontinuities obtained during labor.
• External endometriosis and ingress of blood into the abdominal cavity.

The risk of the appearance of postoperative splices directly depends on the individual characteristics of the patient's body and on compliance with medical recommendations after surgery. That is, abdominal trauma, various pelvic diseases, STDs, abortion, hypothermia and even a prolonged intake of antibiotics, can trigger the appearance of inclusions after surgery on the ovary.

The pathological process goes through several stages in its development.

1. Heavens are localized around the ovary, but do not disturb the capture of the egg.
2. Fabrics expand between the ovary and the fallopian tube, creating obstacles for the egg.
3. There is a twisting of the fallopian tube, but its patency is not violated.

Disorders are characterized by disorders of the menstrual cycle, drawing pains in the lower abdomen and in the lower back, discomfort during intercourse, inability to become pregnant for an extended period of time. Since the symptoms may coincide with the signs of other gynecological or endocrine pathologies, you should consult a doctor and undergo thorough diagnosis.

For the treatment of connective tissue fusion, laparoscopy, laser therapy, electrosurgery or the technique of aqua dissection are used, that is, dissection of tumors with water. The patient is prescribed a course of antibacterial therapy to suppress infection, anti-inflammatory and fibrinolytic drugs, anticoagulants and vitamins.

Spikes after spinal surgery

Scars and adhesions after surgery on the spine occur in almost all patients. This leads to a narrowing of the vertebral canal. In a lesion site, both an infectious and an autoimmune process can develop with a disruption of the CSF movement. Fibrous cords join the spinal roots with herniated intervertebral discs, epidural fiber, and spinal cord membranes. Neoplasms can be as light, or heavy, dense.

The main causes of adhesions in the spine:

• Traumatic hematomas.
• Infectious complications.
• Epidural administration of certain medications.
• Removal of herniated intervertebral discs.

A painful condition begins with aseptic inflammation. In the surgical intervention zone there is swelling, which affects the spinal cord and surrounding tissues. Gradually the inflammatory process passes into the fibroblastic stage, forming dense splices.

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

Spikes after surgery on the lung

Such a problem, like spikes after a lung operation, occurs in 30% of patients who underwent 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 single cavities because of the adhesion of pleural sheets. Heavens form in any place where there is connective tissue.

In addition to operations on the chest, inclusions can occur for the following reasons:

• Pleurisy and transferred pneumonia.
• Bronchitis (acute, chronic).
• Inflammation or lung cancer.
• Congenital malformations.
• Infarction of the lung or infection with parasites.
• Internal bleeding.
• Allergic reactions, smoking, occupational hazards.

The pathological condition has such symptoms: shortness of breath, heart palpitations, respiratory failure, chest pain, various respiratory disorders due to a violation of natural ventilation. Deterioration of general state of health, cough, separation of sputum, elevated body temperature, oxygen starvation, intoxication.

Heaviness adversely affects the functioning of the respiratory system, hampers their work and limits mobility. In some cases, complete overgrowth of the cavities occurs, which causes acute respiratory failure and requires urgent medical attention.

To diagnose the disease, fluorography and X-ray of the lungs are performed. Treatment depends on the neglect of the disease state. Surgical intervention is indicated if inclusions of tissues provoke pulmonary insufficiency and other conditions that threaten life. In other cases, drug therapy and a course of physiotherapy are carried out.

Spikes after a stomach operation

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

Spikes after surgery on the stomach can be aggravated by such factors:

• Injuries to the abdomen (open, closed).
• Increased synthesis of enzymes that cause proliferation of connective tissue.
• Inflammatory and infectious diseases of internal organs.
• Radiation therapy in oncology.

According to medical statistics, 15% of patients develop splices just after surgery. The clinical picture of the pathology is accompanied by such symptoms: traumatic pains, digestive disorders, intestinal obstruction, appetite disorders, severe weight loss, stool problems. Treatment can be both conservative and surgical, depending on the neglect of pathology.

Complications and consequences

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

• Acute intestinal obstruction.
• Respiratory failure.
• Inflammatory and infectious pathologies.
• Obstruction of the fallopian tubes.
• Infertility.
• Peritonitis.
• Necrosis of tissues.
• Bend of the uterus.
• Chronic pain.

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

[29], [30], [31], [32], [33], [34], [35], [36], [37]

Diagnostics of the adhesions after surgery

If there is a suspicion of a postoperative adhesion process, the patient is assigned a set of different examinations. Diagnosis of adhesions after surgery consists of:

• Anamnesis and visual examination.
• Analysis of patient complaints.
• Complex of laboratory studies (blood, urine).
• Instrumental diagnostics (ultrasound, MRI, CT, radiography, laparoscopy).

The results of a comprehensive medical examination can determine the presence of strands, their localization, thickness and even shape. Evaluate the work of internal organs and identify existing violations. Based on the results of the diagnosis, a treatment plan is drawn up.

[38], [39], [40], [41], [42]

Analyzes

Laboratory diagnosis of adhesive process is necessary for determining the degree of its effect on the body. Analyzes are usually prescribed on the basis of clinical symptoms. More often patients complain of pains of different localization and disturbances in work of intestines.

To diagnose a painful condition, it is necessary to pass such tests:

1. A general blood test is a standard study that is administered to all patients, regardless of the alleged disease. Determines the general state of the body and allows you to draw conclusions about the work of all its organs and systems. With adhesive disease in the blood there may be such deviations:

• Leukocytosis - an elevated level of leukocytes indicates an inflammatory process. At the same time, the more stab cells, the more intense the inflammation.
• Anemia - a decrease in the number of red blood cells occurs with bleeding in the body. With postoperative strands, this is a rare deviation, which can be associated with increased physical stress and rupture of adhesions. This condition requires treatment, since a low level of erythrocytes lowers the protective properties of the immune system.

2. Biochemical blood test - reflects the work of internal organs, especially the liver and kidneys. In the pathological condition, such violations are possible:

• Elevated levels of urea - is due to a delay in urine. This is observed when deformed with cords of the walls of the bladder or ureter. Indicates the involvement of the urinary tract in the adhesion process.
• Reduced hemoglobin - is contained in red blood cells, so it can indicate internal bleeding.
• C-reactive protein - indicates an acute phase of inflammation.

An analysis of stool can also be performed, which is performed if there is a suspicion of intestinal obstruction caused by adhesions. With concomitant infertility, a blood test for hormones and analysis of seminal fluid are indicated, which will determine the violations of reproductive functions and whether connective tissue fusion is associated with this.

[43], [44], [45], [46], [47], [48]

Instrumental diagnostics

Another method for identifying the adhesive process is instrumental diagnostics. If suspected of spikes after surgery, the patient should undergo such examinations:

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

According to the results of instrumental diagnostics, the doctor can prescribe the necessary treatment or additional examinations.

Differential diagnosis

On the symptomatology the adhesive process is similar with set of diseases. Differential diagnostics allows to reveal connective tissue soldering and separate them from other pathologies. Since postoperative pain syndrome and the presence of scarring, not always indicate the cervical. At that time, adhesions can simulate kidney damage, peptic ulcer, respiratory failure, pancreatitis, cholecystitis, lumbulgia.

Consider the differential diagnostic signs of adhesions of the abdominal cavity and other diseases of internal organs:

• Injured hernia - the presence of hernial protrusion, pain and tension in the affected area.
• Acute pancreatitis or cholecystitis - intense pain in the right upper quadrant or shingles. Increased body temperature, severe nausea and vomiting.
• Ulcerative lesions of the stomach or duodenum are acute paroxysmal pains in the abdomen, which are intensified by the slightest movement. When fluoroscopy reveals a free gas in the peritoneum.
• Acute appendicitis - pain in the right iliac region, which are intensified when moving. Elevated body temperature and elevated levels of leukocytes in the blood.
• Torsion of ovarian cysts - paroxysmal pains in the lower abdomen. When trying to palpate the abdomen, a volumetric neoplasm is determined.

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

Treatment of the adhesions after surgery

From the general condition of the patient depends the procedure for treatment of adhesions after surgery. Since the main reason for the formation of strands is surgical intervention, the treatment should be as gentle as possible, preferably therapeutic. Operational removal of neoplasms is carried out only in extreme cases, when there is a threat to the life of the patient.

In the early stages of the adhesive process, vitamin E, folic acid and aloe preparations are used. Such remedies prevent the formation of new splices, and make them more elastic.

In acute pathology, laparoscopy is indicated. With its help, the strands are dissected, which allows the normal functioning of the affected organs to be restored. Particular attention is paid to physiotherapy and therapeutic nutrition, which facilitate the patient's morbid state.

Medications

The treatment of postoperative connective tissue fusion is performed both surgically and more conservatively, that is, by a medicamentous method. Medicines for adhesions are divided into:

• Fibrinolytic agents - these preparations contain substances that dissolve fibrin, around the soldering of tissues. Fibrinolysin, Urokinase, Hyaluronidase, Hemotrypsin, Streptokinase, Trypsin, as well as tissue plasminogen activators.
• Anticoagulants - prevent blood clotting. Preparations from the group Citrates and Oxalates, Heparin.
• Antibacterial and anti-inflammatory drugs - prevent the development of infectious and inflammatory complications. Most often, patients are prescribed drugs from the group of tetracyclines, cephalosporins, sulfonamides, NSAIDs, antihistamines or corticosteroids.

Consider the most effective drugs prescribed to patients with postoperative strands of any localization:

1. Streptokinase

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

• Indications for use: obstruction of pulmonary arteries and its branches, thrombosis, occlusion of vessels of the retina of the eye, acute myocardial infarction during the first 10-12 hours, formation of cords on internal organs.
• Method of application: the drug is administered intravenously drip, in rare cases, intraarterially. Initial dosage of 250,000 IU (IE) dissolved in 50 ml isotonic sodium chloride solution. With a pronounced adhesive process, the medication must be administered for a long period of time.
• Side effects: headaches, nausea, chills, allergic reactions, nonspecific reactions to protein.
• Contraindications: increased bleeding, recent bleeding, stomach ulcer, microbial diseases, pregnancy, diabetes, severe kidney and liver diseases, active form of tuberculosis, hypertension.

1. Hemotrypsin

Local application of this drug cleaves necrotic tissues and fibrinous formations, facilitates the dilution of viscous secrets, exudate and blood clots. Contains the active ingredient - chymotrypsin.

• Indications for use: thrombophlebitis, inflammatory-dystrophic form of periodontitis, otitis media, tracheitis. Used in the conduct of physical 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 deeply into the buttocks. The course of treatment is 6-15 injections.
• Side effects: burning in the place of application, allergic reactions, bleeding from the healing sites.
• Contraindications: individual intolerance of active components, intravenous administration, bleeding wounds, malignant neoplasms.

3. Hyaluronidase (Lydase)

Enzyme means used to eliminate joint contracture, soften scarring and hematoma. Contains hyaluronic acid.

• Indications for use: scar changes of the skin of various origins, hematomas, joint contractures, long-lasting non-healing ulcers, scleroderma, traumatic nerve plexus lesions, rheumatoid arthritis.
• Method of administration: the drug is administered subcutaneously to the scar tissue, intramuscularly, by electrophoresis, applications to the mucous membranes. In the ophthalmic practice, the drug is used subconjunctivalally and retrobulbarno. 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 occur.

4. Urokinase

Fibrinolytic, dissolves blood clots due to the activation of plasminogen.

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

5. Fibrinolysin

Affects the blood system and fibrinolysis. It is often used in combination with Heparin. Its activity is based on the natural anticoagulant system of the body and the ability to dissolve the filaments of fibrin.

• Indications for use: clotting of blood vessels with a blood clot of peripheral or pulmonary arteries, recently transferred myocardial infarction, acute thrombophlebitis.
• Method of application: intravenously (drip) with isotonic sodium chloride solution, topically.
• Side effects: increased body temperature, pain in the place of application, allergic reactions, chills.
• Contraindications: increased bleeding, peptic ulcer and duodenal ulcer, tuberculosis, radiation sickness, low content of fibrinogen in the blood.

If the adhesive process is accompanied by severe pain, then Paracetamol, No-shpa or Spazmalgon are used to eliminate them. With local use of antipyretics, electrophoresis, applications and other physiotherapy procedures are performed.

Ointments for adhesions after surgery

To dissolve connective tissue fusion and scars, widely used topical preparations, that is, ointments. From adhesions after surgery, such means are effective:

1. Vishnevsky ointment

Antiseptic, which includes castor oil, xerobes and tar. It is widely used in the treatment of inflammation caused by abscesses or boils. Restores tissue with burns, bedsores and frostbite, is used in gynecology. Promotes softening of postoperative scars and adhesions.

The ointment is evenly distributed over the gauze and applied to the affected areas. The dressings change 2-3 times a day. A weak irritant 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 Purpose-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 tissue. The drug is effective in the treatment of postoperative adhesions and scars.

The drug includes chondroitin sulfate (a structural element of the cartilaginous tissue), sinus organ components that slow down the degenerative changes in the cartilaginous 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, tendopathies, spondylarthrosis, deforming osteoarthritis), traumas and surgical interventions, after which spikes and contractures were formed.
• Method of application: a small amount of ointment should be applied to the lesion site 2-5 times a day. The product can be used during massage and with various physiotherapy procedures.
• Side effects: allergic reactions, skin itching, rash. Symptoms of overdose are not fixed. Ointment is contraindicated in case of individual intolerance to its components.

3. Heparin ointment

Reduces the inflammatory process, prevents blood clotting, expands the surface vessels, and anesthetizes.

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

4. Hydrocartisone ointment

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

Gels for adhesions after surgery

In addition to ointments, you can use a gel to treat an adhesive process. This dosage form does not contain fats and oils, viscous and soft in composition and consistency. Gel on 70% consists of thickeners and water, so its active components quickly penetrate into the wound surface.

Consider the popular gels for adhesions after surgery:

1. Traumeel Gel

Complex homotoxic agent with regenerating, analgesic, anti-inflammatory and anti-exsessive properties. Quickly removes puffiness and stops bleeding. Increases the tone of blood vessels 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 adhesions, purulent-inflammatory diseases.
• The gel is applied a thin layer on 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 the intolerance of the components of the drug.

2. Intercott

Gel, used for laparotomy and laparoscopic operations in gynecology and surgery to reduce the number of postoperative strands. The dispersant is a compound of polyethylene oxide and sodium carboxymethylcellulose.

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

3. Kontraktubeks

Antiproliferative, anti-inflammatory, softening and smoothing scar tissue preparation. Contains 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. Also in the gel is heparin and allantoin, which accelerate the healing process, improve the permeability of tissue, slow down the synthesis of collagen.

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

4. Mesogel

Anti-collating agent based on carboxymethylcellulose polymer. It is used for surgical interventions, after which there is a risk of adhesion. Does not have a general toxic, local irritant or allergic effect. Effective in the presence of exudate or blood, is not encapsulated and is not a nutrient medium for pathogens.

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 gliding of organs, reduces the level of fibrin. It is produced in sterile syringes with a volume of 5-100 ml and in polymer containers of 200 ml.

• Indications for use: prevention of cervical formation in operations on organs and tissues with increased formation of adhesions.
• The method of administration and dose depend on the packaging of the medicine and the procedure for the operation. The gel is applied to the areas of the tissues on which the formation of strands is possible. The agent is applied a thin layer on the surface to be 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 by increasing the volume and splitting its molecules into short fragments. If the drug is used in the abdominal cavity, its molecules are absorbed into the capillary network of the peritoneum, penetrate the lymphatic system through the serous shell 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 fusion after surgery (especially with gynecological or urological manipulations), a suppository against adhesions is recommended. After the operation, you can use these drugs:

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 surgical interventions. Suppositories should be administered after a cleansing enema, the duration of therapy and the frequency of application are determined by the attending physician.

2. Longitude

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

• Indications for use: diseases accompanied by proliferation of connective tissue. Most often appointed 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 injected rectally after cleansing the intestine 1 candle once every 48 hours or vaginally 1 piece. Every three days. The duration of therapy is determined by the attending physician. If necessary, a second course of treatment can be prescribed, but not earlier than 3 months after the end of the previous one.
• Side effects: systemic or local allergic reactions.
• Contraindications: intolerance of active components, expressed violations of kidney function, malignant neoplasms, patients younger than 12 years. With special care is prescribed for patients with renal insufficiency, recent bleeding, with an acute form of an infectious disease.

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

Vitamins

To treat and prevent the formation of adhesions after surgery, patients are advised to use vitamins. In the fight against strands, tocopherol (vitamin E) and folic acid (vitamin B9) proved to be well established.

1. Tocopherol

Vitamin E is an active antioxidant that protects various substances from oxidation, for example, retinol or polyunsaturated fatty acids. A 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 internal tissues, especially liver parenchyma.

• Indications for use: muscular dystrophy, CNS diseases, dermatoses, spasms of peripheral vessels, various disorders of motor activity, complex treatment of cardiovascular and ophthalmic diseases.
• The method of application and dosage depends on the form of the preparation, the indications for use and the individual characteristics of the patient's body.
• Side effects: increased doses of vitamin cause gastrointestinal disorders, decreased efficiency and creatinuria.
• Contraindications: destructive changes in the heart muscle, myocardial infarction, high risk of thromboembolism.

The lack of vitamin E can be associated with a decrease in red blood cells in the blood. Vitamin has several forms of release: vials, oily solution, capsules for oral administration, ampoules for intravenous or intramuscular injection.

2. Folic acid

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

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

• Indications for use: hyperchromic macrocytic and megaloblastic anemia, normalization of erythropoiesis, anemia and leukopenia, pellagra, pernicious anemia, postoperative conditions, improvement of the epidermal state.
• How to use: tablets are recommended to be taken orally after meals. As a rule, 3-5 capsules per day. The course of treatment is 20-30 days.
• Side effects: in rare cases, there are allergic reactions, which are stopped with the use of antiallergic medicines
• The main contraindication is individual intolerance to folic acid. There have been no cases of overdose.

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

Physiotherapeutic treatment

One of the effective methods for eliminating postoperative adhesions is physiotherapy. Most often, this therapy is prescribed for accretions in the pelvic organs.

The main goal of physiotherapy:

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

The most noticeable effect is possible in the first months of the illness, when the strands are not too rigid and strong. Treatment prevents them from strengthening and prevents the proliferation of new tissues. In the adhesive process, the following methods are used:

• Ozokerite and paraffin applications.
• Electrophoresis with resorbants and anesthetics.
• Laser or magnetic therapy.
• Electrostimulation.
• Ultrasound and massage.
• Hirudotherapy.

Let's consider more in detail the most effective physiotherapy procedures:

1. Ozokeritic and paraffin applications are aimed at heating the organs of the small pelvis. By their action they are similar to laser therapy and ultrasound. Increase local immunity, stimulate blood circulation and lymph drainage. Applications are contraindicated for inflammatory lesions of the small pelvis and for skin diseases.
2. Ultrasound - a method of affecting organs and tissues with the help of ultrasonic waves. Accelerates metabolic processes at the molecular level. Promotes the destruction of pathogens in chronic foci of infection. Destroys the microstructure of the adhesions, increases their elasticity.
3. Laser therapy - heating of the affected tissue to stimulate blood circulation and prevent the formation of collagen protein (the basis of adhesive and scar tissue). This method is especially effective in the early stages of the pathological process.
4. Electrostimulation is based on sending electrical impulses with a special device to the affected tissue. Stimulates blood circulation and lymph drainage, strengthens regeneration processes, minimizes painful sensations.
5. Electrophoresis - this procedure consists of hardware and medicamental effects. With the help of an electric field, drugs containing enzyme hyaluronidase (Lydase, Longidase 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 work of organs even with the launched connective tissue formations. The technique is absolutely painless, but has a number of contraindications: severe intoxication, blood diseases, oncology, cachexia, heart rhythm disturbances, intolerance of medications used.
6. Treatment with leeches (hirudotherapy) - the effectiveness of this method is based on the enzyme hyaluronidase, which is part of leeches. It softens the adhesions and makes them permeable for drugs, reduces their size. As a result of this treatment, the mobility of organs is restored, and painful sensations decrease. Leeches put on problem areas for 30-40 minutes. In this case, the skin should not be wounded or otherwise damaged. As a rule, patients are prescribed 7-10 sessions. This method has no contraindications and side effects.

Physiotherapy treatment is also carried out with the triggered adhesive processes, which led to deformation of the organs and the appearance of acute pathological symptoms. Such therapy can minimize pain and improve the patient's condition.

Alternative treatment

In addition to medical and surgical therapy of postoperative strings, alternative treatment is often used to eliminate them. Unconventional therapy prevents the growth of tumors. Consider popular alternative recipes:

• Take 50 g of flax seeds, wrap them in a gauze flap and dip in 500 ml of boiling water for 5-10 minutes. Cool and apply to a sore spot for 1-2 hours 2-3 times a day.
• A tablespoon of dry herb St. John's wort pour 250 ml of boiling water and cook over low heat for 10-15 minutes. The resulting broth strain, and take ¼ cup 3 times a day.
• Take two parts of the dog rose and nettle, mix with one part of the cowberry. The resulting mixture, pour 250 ml of boiling water and let it brew for 2-3 hours. Take ½ cup twice a day.
• Take in equal parts the grass of a clover, a thousand-year-old man and a mother-and-stepmother. Pour 250 ml of boiling water and let it brew for 1.5 hours. Take ¼ cup 3-5 times a day.
• The healing properties of the oil is black cumin, which can be purchased at the pharmacy. It contains phytosterols, tannins, carotenoids and fatty acids. It has antibacterial, regenerating and anti-inflammatory action. The oil can be used for wetting tampons, for douches, for external or internal use.

Alternative treatment of adhesions after surgery should be carried out only after consultation with the attending physician and only if the pathological process proceeds in an easy form.

[49], [50], [51], [52], [53], [54]

Herbal Treatment

Another option for alternative treatment of adhesions is the treatment with herbs. Consider the popular recipes based on herbs:

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

Treatment with herbs should be done with extreme caution and only after medical approval. Particular attention should be paid to the proportions of medicinal components.

Homeopathy

For the treatment of strands of different localization, not only traditional medicine, but also alternative methods are used. Homeopathy is one of the last. In the postoperative adhesive process, the following preparations are recommended:

• Arsenicum album - painful neoplasm after traumas.
• Calcarea fluorica - strands after operations, deep wounds and various injuries.
• Cundurango - coagulation and ulceration in the oral cavity.
• Dulcamara, Euphrasia, Plumbum, Rhus toxicodendron, Thuja - proliferation of connective tissue in the nose.
• Ranunculus bulbosus - cords after pleurisy.
• Silicea - is used for intergrowths after operations, injuries and wounds. Stimulates the body to the accelerated resorption of fibrous formations and scar tissue.

Homeopathic preparations can be taken only for the prescription of a homeopath physician, who selects a medicine (dosage, course of treatment) individually for each patient.

Operative treatment

If the adhesive process in a neglected or acute condition causes 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 the blood supply, interfering with the normal functioning of the digestive tract and other organs.

Surgical treatment can be carried out by such methods: laparoscopy and laparotomy. This takes into account the fact that cavitary surgery can cause new connective tissue fusion. Therefore, when choosing a method, they prefer less traumatic.

1. Laparoscopy

Refers to low-traumatic operations. Through a puncture in the abdominal cavity, the doctor enters a fiber optic tube with a miniature camera and lighting. Through additional incisions, surgical instruments are introduced, with the help of which the adhesions are cut and the blood vessels are cauterized. The dissection can be carried out with an electron-knife, laser or hydraulic pressure. After such an operation, recovery is quick and with minimal complications. But still there is no guarantee that the relapse will not happen again.

2. Laparotomy

Assigned with a large number of adhesions. The operation is performed through an incision (10-15 cm) of the anterior wall of the peritoneum to obtain extensive access to internal organs. The method is traumatic, long-term recovery with mandatory course of anti-collapsed physioprocedures.

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

Particular attention should be paid to the postoperative period. It is necessary to provide the intestines with functional rest until the wound is completely healed. To do this, give up food in the first days after the operation and take only liquid. On the second or third day, you can take a little liquid diet food (broths, grated cereals, vegetable purees). As the condition improves, that is, after about 7-10 days, you can gradually restore the diet.

After surgery, it is strictly forbidden to drink alcohol, strong coffee and tea, confectionery, spicy, salty, fatty or fried. Compliance with the diet allows you to quickly recover after treatment and prevent the emergence of new strands.

Removal of adhesions after cavitary operations

In many patients, after surgery or prolonged inflammatory processes, scars appear, that is, strands. Such fissures disrupt the work of internal organs and cause acute painful sensations. This is the main indication for the removal of adhesions. After the abdominal operations, the laparoscopic method is most often used.

If the pathological process is started, then a laparotomy is performed. This method has such indications:

• The proliferation of connective tissue to the entire abdominal cavity.
• Appearance of purulent formations in the intestine.
• Severe intestinal obstruction.
• Acute inflammatory process in the abdominal cavity.

With laparotomy, access to internal organs is carried out through a cut incision in the abdominal wall, that is, as with a full-blown operation. With laparoscopy, several small incisions are made through which the equipment is inserted. And in the first and second case, the operation lasts about 1-2 hours. The patient is waiting for a long recovery period and a set of preventive measures.

Exercise against adhesions after surgery

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

Consider an approximate complex of protivosipachnye exercises:

• Sit on the floor and pull out your legs exactly. Bend them at the knees and pull them to your chest, slowly straightening to the starting position.
• Lay down on the floor, lay hands on the head, legs bent at the knees and stand on the floor. Slowly lift the shoulder blades.
• Lying on the floor, bend your knees, squeeze the shoulder blades to the floor, hands stretch along the body. Gradually raise the pelvis, lowering the knees on the chest, and return to the starting position.
• Lay down on the floor, put your hands under your buttocks, legs straight, raised. Kneel crosses (scissors). Another option of this exercise is a bicycle, with the movements being of a large amplitude, directed towards the peritoneum and chest.

Therapeutic properties of yoga, which is based on breathing belly. Gymnastics in combination with proper nutrition speeds up the healing process and alleviates painful symptoms.

[55], [56], [57], [58]

Prevention

Methods of preventing adhesion process are based on the reduction of tissue damage in various surgical interventions. Prevention consists of protecting the abdominal cavity from ingress of foreign objects (dressing material) and thorough sanitation of the operating 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, proteolytic enzymes. Particular attention is paid to medical gymnastics and physiotherapy with medications (electrophoresis with Lydasa).

Important as a preventive, and rehabilitative value is nutrition. Let's consider the basic dietary recommendations:

• You can not starve or overeat, as this aggravates the pathological condition and can cause complications.
• You should observe a regime of meals at certain times. Meals should be divided, eat small meals 4-6 times a day.
• From the diet should be excluded heavy and fatty foods, foods with high fiber content and causing flatulence (legumes, cabbage, radish, turnip, radish, grapes, corn). Under the ban come carbonated and alcoholic beverages, spicy seasonings and sauces, whole milk.
• In the menu there should be food rich in calcium, that is cottage cheese, cheese, sour-milk products. They promote peristalsis of the intestine. In this case, the food should be at room temperature, because too cold or hot can cause spasms.
• Patients should use low-fat broth, steamed, boiled or baked low-fat varieties of meat and fish. You can eat greens, vegetables and fruits. In this case, it is necessary to refuse marinades and smoked products.

To prevent the development of adhesions, you need to treat constipation in time, avoid food poisoning and inflammatory processes. You should lead an active lifestyle, but avoid heavy physical exertion. The above recommendations minimize the risk of developing pathology.

[59], [60], [61], [62], [63], [64]

Forecast

Single spikes after surgery have a favorable prognosis, while multiple lesions cause a number of serious and even life-threatening complications. To prevent strings, it is necessary to lead a healthy lifestyle, observe a diet and all medical recommendations. Also do not forget that the emergence of connective tissue fusion is largely dependent on medical competence, adherence to technology and the rules of the operation, adequate postoperative recovery.

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