Injury to small and large intestine: Almost all lesions can be immediately oversewn using standard technique. For this, it is best to use 3-0 or 4-0 atraumatic suture material.
If the intestine around the lesion is not mobile, sewing will result in excessive tension on the suture. Therefore, the intestine must be sufficiently mobilized before suturing.
Larger defects may require segmental resection.
Devascularization: In extensive adhesions, injuries/bleedings can occur in the mesentery area. This can lead to a perfusion disorder of the affected intestinal segment. In case of doubt, segmental resection is required here.
Diffuse bleedings: Depending on the extent, adhesiolysis results in the formation of a huge wound surface. Even with the most subtle preparation, there is diffuse bleeding from all quadrants. By packing with abdominal towels and waiting, the superficial bleedings stop on their own, only stronger bleedings then need to be selectively ligated or coagulated.
Adhesions with the liver: Detaching the intestine and the omentum from the lower edge of the liver usually leads to a more or less extensive deserosalization of the organ with corresponding bleeding tendency. Actually, short-term tamponade with a moist abdominal towel is sufficient here, possibly spray coagulation or a hemostypticum.
Tip: Since the vast majority of patients with adhesions have been previously operated on, the surgeon should, if possible, study the old surgical reports preoperatively to get an approximate idea of the expected situs, because
sometimes the anatomy is significantly altered by the previous interventions.