Background Information:

What are the other Names for the Procedure?

• Adhesiolysis
• Lysis of Adhesions
• Lysis of Scar Tissue

What is Separation of (Lysis of) Adhesions surgical procedure?

Separation or Lysis of Adhesions is the surgical removal of an abnormal formation of a fibrous band occurring between neighboring tissues and/or organs. The reasons for formation of these adhesions are as follows:

• Previous surgery in the affected part of the body
• Trauma
• Inflammatory disease
• Endometriosis
• Congenital defects
• Chemotherapy or radiation treatments for cancer

What part of the Body does the Procedure involve?

Adhesions are often observed in the organs of the abdominal cavity. However, other parts of the body maybe affected too. Separation of (Lysis of) Adhesions procedure is confined to the affected parts of the body.

Why is the Separation of (Lysis of) Adhesions surgical procedure Performed?

• The Separation of (Lysis of) Adhesions surgical procedure is performed to repair or remove partial or complete obstruction caused by adhesions
• It may also be performed in case of any complications arise due to the presence of an adhesion

What are some Alternative Choices for the Procedure?

• Conservative medical management (non-surgical approach) is done in some cases of bowel obstruction that are due to adhesions
• However, if the adhesions lead to complications, then it is best separated surgically
• Additionally, a form of physical therapy called the ‘Wurn technique‘, is also considered by a few

What are the Recent Advances in the Procedure?

The recent advances in the procedure are the use of laparoscopic techniques. However, these are best suited for adhesions that are not complex.

What is the Cost of performing the Separation of (Lysis of) Adhesions surgical procedure?

The cost of Lysis of Adhesions procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/001493.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356393/

http://clarkgerhart.com/ard.html

Prior to Separation of (Lysis of) Adhesions surgical procedure:

How is the Separation of (Lysis of) Adhesions surgical procedure Performed?

• An incision is made on the skin. Next, the surgeon goes through the tissue, muscles, and organs to locate, isolate, and separate the adhesion
• The surgeon may also thoroughly inspect neighboring organs and tissues to check for any disease and may perform additional surgical procedure as required
• If the adhesions have caused strangulation of the affected organ, then the organ may need to be removed
• After a thorough Lysis of Adhesions, the surgeon repositions the organs, muscles, tissues, and closes the skin with sutures

Where is the Procedure Performed?

Separation of (Lysis of) Adhesions procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

A general surgeon performs the surgery along with an anesthesiologist.

How long will the Procedure take?

The surgery may take anywhere between 1 to 6 hours depending on the severity of the adhesions. On an average, the surgery time is found to be 2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

• The patient must avoid alcohol, nicotine, and nicotine-based products
• They must keep a check on their blood sugar count, which must be brought under control either with medication, or a combination of medicines with insulin; as suggested by the physician
• Apart from this, the physician may evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are currently being taken
• Some of the medications may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevents them from undergoing the procedure
• A physician will request your consent for the Separation of (Lysis of) Adhesions procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Separation of (Lysis of) Adhesions surgical procedure?

The surgeon may recommend any of the following tests to be performed before the surgery:

• Routine blood tests
• CT Scan or MRI of the affected part
• X-rays
• Barium enema

The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do all or a few of the above tests, as directed by the physician.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is an adhesion? What is Separation or Lysis of Adhesions?
• Why is this procedure necessary?
• What does the procedure involve?
• How will this procedure help?
• How soon should I get it done? Is it an emergency?
• What are the alternatives for treating the adhesions?
• Can oral medications solve the problem?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• After the surgery are there chances of another adhesion forming?
• Does surgery ensure a complete cure?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Separation of (Lysis of) Adhesions surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during the procedure.

How much Blood will you lose, during the Procedure?

• The amount of blood lost varies from person to person and the severity of the adhesion
• In an open surgery the amount of blood lost is more than a minimally invasive surgery. It is difficult to quantify the amount of blood lost
• However, blood transfusion is immediately given to the patient, if the individual suffers from an excessive loss of blood

What are the possible Risks and Complications during the Separation of (Lysis of) Adhesions surgical procedure?

The possible risks and complications that may arise during the surgery are as follows:

• Excessive bleeding
• Infection
• Blood clot formation
• Accidental injury to neighboring organs and tissue

What Post-Operative Care is needed at the Healthcare Facility after the Separation of (Lysis of) Adhesions surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Separation of (Lysis of) Adhesions surgical procedure:

What are the possible Risks and Complications after the Separation of (Lysis of) Adhesions surgical procedure?

The possible risks and complications after the surgery depend on the area where the adhesion was located. A few general and specific complications that may arise are:

• Recurrence of the adhesion
• Incisional hernia
• If the adhesion is located in the eye, it could result in glaucoma
• Partial or complete bowel obstruction, if the adhesion is located in or around the intestines
• Pelvic or uterine adhesions in women can lead to infertility

What is the Prognosis after the Surgery?

An adhesion may recur due to the surgery itself and present symptoms anywhere within 1 to 30 years, after the surgical procedure. In a particular study, the rate of recurrence was found to be 18% after 10 years and 29% after 30 years.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Excessive pain around the surgical wound
• Bleeding
• Signs of infection
• Nausea
• Dizziness
• If any new symptoms are observed

What Post-Operative Care is needed at Home after the Separation of (Lysis of) Adhesions surgical procedure?

The patient is advised the following post-operative care at home:

• Keep the surgical wound clean and dry and while bathing; clean the wound with soap
• Use heating pad or warm compressors to relieve incisional pain
• Avoid any strenuous activity
• Complete the course of prescribed medication
• Take stool softeners to prevent constipation
• Resume your daily activity as soon as you are able to (per physician’s advice)
• Avoid sex till healing is complete, or as advised by the physician

How long does it normally take to fully recover, from the Procedure?

It may take place anywhere between 6-8 weeks for a complete recovery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

In some patients, the tissue is sent for further examination and discarded as per standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Separation of (Lysis of) Adhesions surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• A general surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA