One of the problem areas which arise from surgery for endometriosis is the formation of adhesions. Fortunately, there are continuous developments and improvements in both techniques and procedures which have proven to be of great value. These new methods are also improving the chances for conception after surgery for women with endometriosis.
Endometriosis-A Far Reaching Condition
Endometriosis is the presence of cells similar to those that grow in the uterus (endometrial cells) that are growing outside of the uterus. These are called endometriosis implants and are commonly found on the ovaries, Fallopian tubes, outer surfaces of the uterus or intestines and on the pelvic lining. They may also grow in the vagina and cervix and can be found on the bladder as well. Although they can be very problematic, they are not cancerous.
Dealing With Endometriosis And Adhesions
One of the common ways of dealing with endometriosis is through surgery to remove the lesions either by laparoscopy or diathermy. Adhesions may form after surgery, or they may be caused by the endometriosis itself. Women who have advanced stages of endometriosis, stage 3 or stage 4, often have adhesions even prior to surgery. The use of adhesion barriers often helps to reduce the risk of more adhesions following excision of endometriosis from the body.
Of course, there is no better way to prevent adhesions than with excellent surgical technique, and a method that minimizes tissue injury and heavy bleeding is preferred. It is important to prevent blood loss since excessive abdominal bleeding increases the likelihood of adhesions. If bleeding is unavoidable, then adequate irrigation to remove the blood from the intra-abdominal area is important.
Preventing Adhesions Through The Use Of Barrier Agents
There are different types of barrier agents which can be used to minimize the growth of adhesions, which include non-absorbable barriers, absorbable barriers and fluids. Each of these agents work by separating damaged tissue during the healing process, which is when adhesions form. Non-absorbable agents such as Gortex were originally used during heart surgery. They have to be sutured into place and do not dissolve which means a second surgery to remove the sutures. As a result, this type of barrier is not used in treatment of gynecological issues.
Interceed is an absorbable barrier which is made from regenerated cellulose. A mesh which does not require suturing, interceed is draped over the injured tissue and within an eight hour period it forms a gelatinous protective layer which is absorbed into the body in about two weeks. Interceed has reduced adhesion formation by 50 percent. Another option is Seprafilm which is an absorbable membrane that becomes a hydrated gel within 24 hours of placement and is absorbed into the body within seven days. This product has been very effective in reducing adhesions in abdominal surgery.
A New Product Soon On The Market
There are many advantages to fluid adjuvants because they coat all surfaces rather than being localized, as barrier agents are. A new product called Spraygel is currently being tested in the United States. Two liquids are mixed during spraying and together they form an absorbable hydrogel. It adheres and remains intact for five to seven days and then it is absorbed and excreted. This amazing product has decreased the frequency and amount of adhesions by 70 percent.
