Obstructions

Hi Steve,
Althought I do not ususally make many adhesions I do get a few so when they did my hernia surgery with mesh they snipped a few along the way...ditto for the galbladder surgery and the other hernias...whenever he is in there he snips the few that have grown back. I don't know if I will get a lot or not but at least for the last while they have been kept at bay. I didn't even ask him to snip them, it was just natural for my surgeon to do what he felt necessary for me to feel better and have fewer problems.
I know that some surgeons do not cut adhesions unless they absolutely must because they say that more grow back. I don't know enough to say if it is true or not but a second opinion is always useful.
Hope that you find someone who can take care of both at the same time.
Sharon

This is a tough call. Certainly, all surgeons will release adhesions in their way when they are doing surgery. But, venturing off into other areas of the abdomen to "look" for other adhesions can be problematic. To do it properly, they have to run their hand along the entire length of small bowel, which is 20 feet or so. Sometimes, the troublemakers are pretty evident, by the effect they have on the surrounding bowel. But, everything is all wet and squishy in there (not at all like that model in your doctor's office!), so these things do not necessarily stand out.

The process of manipulating the tissues is what is thought to be the cause of the adhesions. So, a surgeon who has a gentle, tender touch is going to be better at avoiding adhesions than one who is in a hurry because he has a very full schedule. Also, a surgeon with thin, nimble fingers is a good thing too. If you ever noticed, orthopedic surgeons have hands like a carpenter, because they are using hammers, chisels, drills, and similar brutish objects.

If you are serious about the adhesion release, it makes sense to do it while having your hernia repair, especially when mesh is being used, as mesh makes a pretty tough obstacle for later surgery. You can ask around, but most surgeons don't like to go there unless it is an emergency, or you are unable to eat at all.

Jan

Jan

Yes I can eat but I am getting the blockages every other day. Most of the time its partial blockages but every once in awhile it's a total blockage. It is always in the same spot, below my stoma scar. The xrays do not show anything, but I have not taken the xray with a full blockage. I am pretty sure my colo rectal surgeon would go in there but I am not sure I want to use him again. To far from home.

The fact that you have nailed it down to a specific area is good. The stoma site is the most common area for problematic adhesions to form. So, I do not think it is unreasonable to ask your general surgeon to take a peek at your stoma area while repairing the incisional hernia. If this was an inguinal hernia, that probably would be too far away from the surgical field. When I had my midline incisional hernia repaired (yes, I had a mesh repair also), my surgeon even explored down to the j-pouch area to make sure all was well. But, I must admit, he was my j-pouch surgeon too, so he may have wanted to admire his own work (or something similar). He was a local general surgeon too, so it was convenient.

I suppose he released some adhesions while in there, but it was not part of the planned surgery. Nearly 20 years later, I do get a few obstructions a year, but just partials. If it were every other day, I would be a BIG squeaky wheel, I can guarantee that!

Jan

They check for the inguinal hernia but I did not have one. The blockage spot is actually out of the surgical field I think. Its below the stoma, my hernia is at the belly button. I am not sure why the adhesions are around the stoma sight. I may have to go to my colorectal surgeon except he is one those you described that rushes.

Perhaps out of the immediate field, but close enough. Depends on how big of an incision they need to do your umbilical hernia repair. If it is 4 inches or so, probably big enough to take a looky-loo. You'd be surprised how much they can stretch that opening! Depends on how much "real estate" is between the two areas. My incisional hernia was the midline below the umbilicus.

You don't need a colorectal surgeon for lysis of adhesions, especially since it is not near your pouch. Every general surgeon is well versed in ostomies and their complications.

If doing this while you have your hernia repair is a no-go, ask around about laparoscopic lysis of adhesions. Worth looking into!

Jan

Hello Everyone

Well I gone to two surgeons and they both do not want to operate on me for the adhesions. Meanwhile I am having a blockage at least once a week. They say the adhesions will come back and its to dangerous with all the surgeries I have had. My view is they are alreay here. I am thinking I am going to see my original surgeon and see what he says.

Surgeons hate bad outcomes, and "lysis of adhesions" is often unsuccessful. OTOH, it does sometimes work. It sure sounds like you're having plenty of trouble, though, and I understand your willingness to try something that *might* help. Have you been careful to rule out other possible causes of blockage?

Steve, if you want I can refer you to my CR surgeon up here in KC. I know it's a drive, but after a year of obstructions and a Small Bowell Series (SBS x-ray series), she scheduled me for adhesion lysis surgery. I also thought I had an incisional hernia, and asked the general surgeon (who had fixed an inguinal hernia the year before) if he would be willing to take a look and fix it if needed. He agreed and was there after my surgeon was done but did not find a hernia. They both work laproscopically.

My adhesion lysis was successful! I have not had a complete obstruction since my surgery and nary a partial obstruction either. She took pictures and showed me the two major (of the 3 or 4) adhesions that were causing problems.

Message me if you want her contact information, and I'm happy for you to let her know I referred you.

Steve

Scott

I am not sure what the other causes of blockages could be. Do you have some other ideas?


Elmer

Thanks, I will keep that in mind. I am got an appointment with my original CR surgeon in Houston and I am sure he will do it. I just wanted to stay local so I was looking at other surgeons.

I don't know all of the other causes. We've heard from folks here who get blockages (or things that act like blockages) from causes like overdoing bowel slowers, constipation, ileus, mushrooms, quinoa, big salads, and (perhaps) dehydration. And some kinked bowel from an adhesion can contribute to those, too, so it's difficult to sort out. Particularly if you aren't experiencing complete obstruction (which might result in vomiting, intense pain, and dehydration), any other causes should be considered carefully before choosing iffy surgery (or really any surgery). When a surgeon says "no" to surgery it's time to think hard before pressing on.

For example, I had two surgeons refuse to constuct a J-pouch for me. I did press on, but first I spent many hours in a medical library to make sure I understood where they might have gone wrong.