Open Adhesiolysis

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  • Small bowel obstruction caused by intra-abdominal adhesions
  • Adhesions encountered during reoperative abdominal surgery
  • Poor cardiopulmonary reserve
  • Inability to tolerate general anesthesia
  • Operating room with general anesthesia
  • Conventional open laparotomy instrument tray
  • The small intestine is most commonly involved with postoperative adhesions.
  • The entire small intestine extends from the pylorus to the cecum and measures 270 to 290 cm. It consists of the duodenum, jejunum, and ileum.
  • The duodenum measures approximately 20 cm.
  • The jejunum measures 100 to 110 cm.
  • The ileum measures 150 to 160 cm.
  • The ligament of Treitz is a peritoneal fold tethering the duodenojejunal junction.
  • The jejunum has a larger circumference and is usually thicker than the ileum.
  • The small intestine is supplied primarily by the superior mesenteric artery.
  • The venous drainage of the small bowel consists of the superior mesenteric vein.
  • The vagus nerve provides parasympathetic innervation to the small intestine.

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  • The patient recovers from surgery in the postanesthesia care unit and is transferred to the regular ward.
  • Pain is managed with patient-controlled analgesia or epidural in the early postoperative period while the patient receives nothing by mouth (is NPO).
  • Chemoprophylaxis for deep vein thrombosis is administered daily.
  • The patient is encouraged to ambulate on postoperative day 1.
  • Incentive spirometry may be used to counteract postoperative atelectasis.
  • The nasogastric tube is removed on postoperative day 1 or 2.
  • The Foley catheter is removed on postoperative day 1 or 2.
  • Oral intake is initiated when there is evidence of return of bowel function. The diet initially consists of clear liquids and is gradually advanced based on the patient's tolerance. IV fluids are set at maintenance rate while patient is NPO.


  • Inadvertent enterotomy
  • Bleeding
  • Damage to other abdominal organs involved with adhesions


  • Wound infection of abdominal incision
  • Intra-abdominal abscess
  • Adhesiolysis is commonly performed during the course of abdominal operations. It may be a primary focus of the case, as for small bowel obstruction from adhesive bands, or it may be performed to define anatomy and facilitate further dissection in the reoperative setting.
  • Approaching adhesiolysis in a methodical manner with emphasis on maintaining good visualization and establishing traction and counter-traction in the area of dissection are key components of a successful procedure.
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