Adhesiolysis, open

The surgical sequence demonstrated here is based on the example of a patient with complete adhesiolysis following previous midline laparotomy.

Following appropriate prepping and draping, excise the old scar and extend the incision craniad and caudad, if necessary.

Tip: Before excising the scar always check that there is enough skin available. Otherwise, it will be difficult to achieve tension-free skin closure, resulting in ugly scars and impaired wound healing.

Now transect the subcutaneous fatty tissue with the scalpel or electrocautery.

Tip: Often, small incisional hernias are encountered as sequelae of previous operations. After dividing the fatty tissue these hernias grant direct access to the abdomen. Any adherent intestinal segments here can be easily injured.

Expose the fascia and transect it in the median line with the scalpel.

Tip: After previous operations, always open the fascia with a scalpel. Any adherent parts of the intestine would quickly be injured by electrocautery, whereas the intestines are able to “evade” the carefully dissecting scalpel.