Open Adhesiolysis

No Video Available
Procedures Consult Mobile
Quick ReviewFull DetailsChecklist
Pre-ProcedureProcedurePost-Procedure
Help  |  Print
SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Small bowel obstruction caused by intra-abdominal adhesions
  • Adhesions encountered during reoperative abdominal surgery
CONTRAINDICATIONS
  • Poor cardiopulmonary reserve
  • Inability to tolerate general anesthesia
EQUIPMENT
  • Operating room with general anesthesia
  • Conventional open laparotomy instrument tray
ANATOMY
  • 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.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • 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.
COMPLICATIONS

Intraoperative

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

Postoperative

  • Wound infection of abdominal incision
  • Intra-abdominal abscess
RESULT ANALYSIS
  • 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.
About Procedures Consult | Help | Contact Us | Terms and Conditions | Privacy Policy
Copyright © 2017 Elsevier Inc. All rights reserved.