Injury to the small and large intestines Almost all lesions can be sutured immediately in standard technique. It is best to use atraumatic suture material 3/0 or 4/0.
If the intestine around the lesion is immobile, too much tension will be applied to the suture when suturing. Therefore, free the bowel enough before suturing.
Larger defects may require segment resection.
Devascularization: Extended adhesions may result in mesenterial injury/bleeding. This may impair the blood supply of the affected bowel segment. If in doubt, resect the segment.
Diffuse bleeding: Depending on the extent, adhesiolysis results in a large wound area. Even the most subtle dissection may cause diffuse bleeding in all quadrants. While superficial bleeding will resolve by packing with abdominal towels and waiting, only the more severe bleeding requires selective suturing or electrocautery.
Adhesions to the liver: Freeing the bowel and omentum from the inferior aspect of the liver usually leads to some or extensive deserosation of the organ with a corresponding tendency to bleed. But short-term packing with a moist abdominal towel, or possibly electrocautery or a hemostatic usually suffices here.
Tip: Since the vast majority of adhesion patients will have undergone previous surgery, the surgeon should, whenever possible, refer to the old operation note to gain a rough understanding of the surgical field to be expected, since in some cases the previous procedures will have significantly altered the anatomy.