Endometriosis And Adhesions

The most effective way to treat endometriosis is through surgery. Great strides have been made in this arena and new developments and improvements are constantly surfacing. Along with laparoscopy and diathermy, new advances are being made to help minimize the formation of adhesions during surgery while treating endometriosis. By being able to reduce the formation of adhesions, there is greater success in healing and a better chance of conception after the surgery.

How Adhesions Form After Surgery For Endometriosis

The formation of adhesions is dependent upon many different factors. Endometriosis itself can cause adhesions to form, especially in advanced stages of the disease. The amount of peritoneal surfaces that remain following excision surgery may help to anticipate the likelihood of adhesions being formed. The peritoneum is the interior abdominal lining. It is a smooth, transparent membrane that lines the abdomen and doubles back over the surfaces of the internal organs to form a continuous sac. In endometriosis, this lining is often covered with adhesions. The use of adhesion barriers helps to reduce the risk of new adhesions being formed following surgery.

When the surgeon separates adhesions in the abdomen caused by endometriosis he must be careful to minimize injury to tissues by using instruments that do not crush tissue. The prevention of blood loss is also important because the presence of blood can increase the chances of adhesion formation. If bleeding cannot be prevented, then cauterizing is done to control blood flowing into the abdomen. Irrigation may be used to remove excess blood and proper sutures may help to prevent reactions to foreign bodies in the abdomen.

New Products To Prevent Adhesions Include Non-Absorbable Barriers

New products are available to surgeons which prevent adhesions by physically separating damaged tissues during the period of peritoneal healing-the healing of the membrane that covers the reproductive organs. Barrier agents, used for this specific purpose include non-absorbable barriers, absorbable barriers and fluids.

Non-absorbable barriers were initially used during heart surgery. They must be stitched or sutured in place and they do not dissolve. Because of this factor, a second surgery would be required to remove the sutures and as a result, this type of barrier is not commonly used in gynecological surgery.

Absorbable Barriers Do A Better Job

Absorbable barriers include Interceed and Seprafilm. Interceed is a mesh derived from cellulose. It is draped over injured tissue and does not require suturing. It forms a protective gelatinous layer within eight hours and it is absorbed within two weeks. Numerous studies have shown a 50 percent reduction in the formation of adhesions with this product. The downside is that this product requires a complete absence of blood. If bleeding is not completely stopped, there is an increased risk of adhesions. Seprafilm becomes a gel within 24 hours of placements and is absorbed within seven days. It has been shown to reduce adhesions effectively in both bowel and gynecological surgery. The stiff nature of this barrier makes it useful in laparotomies but not in laparoscopies.

Absorbable Fluids For Adhesions-The Best Product But It Won't Be Available For A While

Absorbable fluids have many more advantages because they coat all surfaces as opposed to the limited coverage of barrier agents. A new product called Spraygel is currently in clinical trials in the US. It sprays on and forms a hydrogel. It adheres to the tissues it has been sprayed to and remains intact for five to seven days before it degrades into an absorbable and easily excreted product. Studies showed the frequency of adhesions decreased by 70 percent with Spraygel. Unfortunately, it won't be available in the US for some time.

With this information, a woman can be well-informed and can discuss the possibilities with her surgeon prior to treatment.


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