58740 Lysis of adhesions (salpingolysis, ovariolysis)

Name of the Procedure:

Lysis of Adhesions (Salpingolysis, Ovariolysis)

Summary

Lysis of adhesions involves surgically removing bands of scar tissue (adhesions) that may have formed between pelvic organs like the fallopian tubes (salpingolysis) and ovaries (ovariolysis). Adhesions can cause pain and infertility by binding these organs together abnormally.

Purpose

The procedure addresses pelvic adhesions that can cause:

• Chronic pelvic pain
• Infertility
• Bowel obstruction (in severe cases)

The goal is to separate and remove the adhesions, thereby relieving pain and improving the function of the reproductive organs.

Indications

• Chronic pelvic pain unresponsive to other treatments
• Unexplained infertility
• Previous pelvic infection or surgery leading to adhesions
• Symptoms of intestinal obstruction due to adhesions

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting or stopping certain medications as advised by the doctor
• Undergoing pre-procedure diagnostic tests like ultrasounds or MRIs to locate adhesions

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free during the procedure.
2. A small incision is made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted to visualize the pelvic organs.
4. Surgical instruments are inserted through additional small incisions to carefully cut and remove the adhesions.
5. Once the adhesions are removed, the instruments and laparoscope are withdrawn, and the incisions are closed with sutures or staples.

Duration

The procedure typically takes 1 to 3 hours, depending on the extent of the adhesions.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon (usually a gynecologist with specialized training in laparoscopic surgery)
• Anesthesiologist
• Surgical nurses

Risks and Complications

Common risks:

• Infection
• Bleeding
• Reaction to anesthesia

Rare complications:

• Damage to adjacent organs (e.g., bowel, bladder)
• Adhesion recurrence
• Chronic pain persistence

Benefits

• Relief from chronic pelvic pain
• Improved fertility outcomes
• Enhanced overall pelvic function

Benefits are often realized within a few weeks to months, depending on the extent of the adhesions and the patient's overall health.

Recovery

• Patients usually go home the same day or after an overnight stay.
• Pain and discomfort can be managed with prescribed pain medications.
• Light activities can be resumed after a few days, with full recovery expected within 2 to 6 weeks.
• Follow-up appointments to monitor healing and adhesion recurrence prevention.

Alternatives

• Pain management with medications
• Hormonal treatments to reduce symptoms
• Physical therapy for pelvic pain
• Assisted reproductive technologies like IVF for infertility

Each alternative has its pros and cons compared to lysis of adhesions.

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. Post-procedure, they might experience some pain and discomfort at the incision sites and mild cramping but will receive medications to manage this. Most patients feel significant relief from their symptoms within a few weeks, with adherence to post-surgical care instructions aiding in smooth recovery.