Adhesion Surgery: Isn’t It Romantic?

In the sunset of their 50s, couples have so much more to talk about — such as, what does this pain mean? Is this a hiatal hernia flare-up or a heart attack? Is this arthritis, gout or did I smack my knee into something and forget?

My girlfriend, Julie, and I share a dread of those little calling cards of mortality. Julie spent years in mysterious pain, wondering at one point if she had ovarian cancer. The mother of two sons developed endometriosis and had to have a partial hysterectomy in her late 40s. The pain began within a year of the surgery, a sharp stab in the lower left abdomen that would come and go.

It usually hurt when she was exercising. But it also hurt when she wasn’t.

"I’d be standing in one spot, and it would be horrendous," she says.

Her doctor didn’t know what it was. He ordered a sonogram and a colonoscopy and found no problems. He put her on birth control pills, which — along with the hysterectomy — blocked any pregnancies but did nothing for pain.

Finally, when she was about 53, the doctor suggested extracting the left ovary through laparoscopic surgery.

"I figured as long as I didn’t need it anyway, go ahead and remove it," she says.

That’s when the surgeon saw scar tissue — like rough concrete, as one doctor described it — around the ovary. Pain would result when it caught on the intestines.

Adhesions, they’re called, and they’re a common result of gynecological and intestinal surgery, says Scott Gallagher, assistant professor of surgery at USF Health.

Such surgery causes trauma to the peritoneum, the transparent lining of the abdominal cavity. As it heals, scar tissue develops, which, for many people, is dissolved by the body, Gallagher says.

For people like Julie, who develop adhesions, surgeons like to wait awhile to remove the scar tissue, unless the patient is in terrible pain. From seven days to three months after the operation, adhesions are very dense and difficult to take apart, Gallagher says. They become easier to remove by waiting a year or two.

Surgeons are able to reduce the problem through modern surgical techniques that minimize trauma to the peritoneum, Gallagher says. Surgeons also use sutures that resist formation of scar tissue and apply adhesion barrier film over the wound to reduce the buildup of scar tissue.

That’s what Julie’s surgeon did, after removing the ovary and as much scar tissue as he could. It really cut down the pain. It’s more of a presence now.

"It’s just sort of there," Julie says.

In other words, a good conversation starter.

Reporter Philip Morgan can be reached at (813) 259-7609 or pmorgan@tampatrib.com.

—–

Copyright (c) 2007, Tampa Tribune, Fla.

Distributed by McClatchy-Tribune Information Services.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.