58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)

Name of the Procedure:

Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis)

• Common Name(s): Laparoscopic Adhesiolysis, Salpingolysis, Ovariolysis

Summary

Laparoscopic adhesiolysis is a minimally invasive surgical procedure aimed at removing adhesions, which are bands of scar tissue that can form between organs and tissues inside the abdomen. This procedure often targets adhesions affecting the fallopian tubes (salpingolysis) and ovaries (ovariolysis).

Purpose

Medical Condition or Problem:

• Adhesions causing pain, infertility, or organ dysfunction.

Goals or Expected Outcomes:

• Relieve pain.
• Restore normal organ function and anatomy.
• Improve fertility in women who have adhesions around their reproductive organs.

Indications

Symptoms or Conditions:

• Chronic abdominal or pelvic pain.
• Infertility suspected to be due to adhesions.
• Bowel obstruction caused by adhesions.

Patient Criteria:

• Patients with confirmed adhesions through diagnostic imaging or a history of abdominal surgeries.
• Patients with unexplained infertility.

Preparation

Pre-procedure Instructions:

• Fasting from midnight before the surgery.
• Possible cessation of certain medications as advised by your physician.
• A pre-operative assessment which might include blood tests and imaging studies.

Procedure Description

Step-by-step Explanation:

1. The patient is administered general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted to visualize the abdomen.
4. Surgical instruments are introduced through additional small incisions.
5. The surgeon identifies and carefully dissects the adhesions.
6. Adhesions around the fallopian tubes and ovaries are specifically addressed if present.
7. The instruments are removed, and the incisions are closed with sutures or surgical tape.

Tools and Technology Used:

• Laparoscope
• Specialized surgical instruments (scissors, graspers, dissectors)

Anesthesia:

• General anesthesia is typically used.

Duration

• The procedure usually takes between 1 to 3 hours, depending on the extent of the adhesions.

Setting

• Performed in a hospital or an outpatient surgical center.

Personnel

• Surgeons specialized in laparoscopic surgery.
• Anesthesiologists.
• Operating room nurses and surgical technicians.

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Damage to surrounding organs

Rare Complications:

• Anesthesia-related complications
• Formation of new adhesions
• Bowel injury or urinary tract injury

Benefits

• Pain relief can be immediate but may take a few days to a few weeks.
• Improved fertility and increased chances of successful pregnancy.
• Reduced risk of future complications related to adhesions.

Recovery

Post-procedure Care:

• Pain management with prescribed medications.
• Light activity recommended after 1 to 2 days; avoid heavy lifting for several weeks.
• Follow-up appointment within a week for assessment.

Expected Recovery Time:

• Most patients can resume normal activities within 1 to 2 weeks.

Alternatives

Other Treatment Options:

• Conservative management with pain medications and physical therapy.
• Open abdominal surgery (more invasive but can be necessary in severe cases).
• Hormonal therapy in cases where adhesions are related to endometriosis.

Pros and Cons:

• Laparoscopy is less invasive with quicker recovery compared to open surgery.
• Risks of alternative treatments vary and should be discussed with your healthcare provider.

Patient Experience

During the Procedure:

• Under general anesthesia, so the patient is asleep and feels no pain.

After the Procedure:

• Mild to moderate pain at the incision sites.
• Possible shoulder pain from gas used during surgery (resolves in a few days).
• Discomfort managed with pain relievers.
• Gradual return to normal activities over the following weeks.