|Discussion in 'All Categories' started by Dan Maduna - Jan 3rd, 2013 8:52 am.|
|removed an appendicises laproscopically in September. In November I started feeling some discomfort in the area of the surgery after I had a long walk brisk exercise. This discomfort is continuing to date, though periodically. What could be the problem?|
re: laproscopic surgery to remove the appendix by Dr M K Gupta - Jan 5th, 2013 11:58 pm
Dr M K Gupta
|Dear Dan Maduna
Your problem may be due to adhesion. Postoperative intra-abdominal and pelvic adhesions include the leading reason for chronic pelvic pain, and intestinal obstruction. It can be generally considered that some people are more vulnerable to develop postoperative adhesions than are others. Unfortunately, there isn't any available marker to calculate the occurrence or the extent and harshness of adhesions preoperatively. Ischemia continues to be considered to be the most important insult which leads to adhesion development. Adhesions develop after a personal injury on the normal peritoneal tissue. This injury migh result from surgery, trauma, inflammation, infection, or foreign body placement inside the peritoneal cavity. After injury to the conventional mesothelial cells overlaying the peritoneal surface, the recovery process starts. Vasoactive substances like histamines and kinins are let go of with the disruption of stromal mast cells increasing vascular permeability, which plays a role in the collection of your fibrin-rich exudate that covers the injured area. Two processes occur essentially simultaneously. A single, the fibrin polymers with this exudate interact with fibronectin to make the fibrin gel matrix, which consequently produces fibrin bands involving the injured areas. At the same time, fibrinolysis starts. Fibrinolysis dominates at sites where healing occurs without adhesions. In contrast, if fibrinolysis is impaired, this imbalance may result in the persistence of the fibrinous mass. Subsequently, proliferating fibroblasts invade this area and deposit extracellular matrix material including collagen that contributes towards the formation of adhesion. After elicitation of angiogenesis factors such as vascular endothelial growth factor (VEGF), proliferation of endothelial cells initiates the development of vascular structure inside adhesion tissue. Thus, different mechanistic steps, some of which happen to be described above, regulate the process of healing, with imbalances in a of these potentially contributing to adhesion development. Furthermore, it's likely the activities tend to be pronounced at sites with prior fibrosis, like those undergoing adhesiolysis. Several studies have been conducted to know the mechanisms of adhesion development after surgery along with its prevention. The outcome have been somewhat controversial without bringing about a clear idea of factors affecting postoperative adhesions formation. Despite initial promising link between different measures in postoperative adhesions prevention, none of them are getting to be a regular application. Future studies emphasizing the biological differences between folks who develop postoperative adhesions and people who don't brings a new understanding of the pathophysiology of postoperative adhesions and hopefully cause far better preventive steps.
Laparoscopic adhesiolysis can be tried as method of treatment in case of adhesion.
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