Bride (medicine)

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The Bride (from French brider , "to tie together") describes in medicine a strand of scars in the abdominal cavity . One also speaks generally of adhesions or intra-abdominal adhesions . The term is occasionally used for adhesions in other areas of the body, for example in joint capsules .

There is a fairly high probability that braces develop after abdominal surgery (however, 10.4% of all braids arise without an operative background), but in most cases they are harmless. In rare cases, however, they can also cause narrowing of the intestines. Such adhesions are responsible for 50-60% of all small bowel obstructions . These are believed to be a common cause of chronic pelvic pain.
If it comes to a complete intestinal obstruction, one speaks of a Briden ileus .
In extreme cases, intra-abdominal adhesions can also cut off the blood supply, causing ischemia and necrosis .

Diagnosis

When the abdominal cavity is open, the surgeon can easily recognize the clamps. Laparoscopic braces can usually be recognized well, although the overview in the abdominal cavity is impaired by the braces.
Brides are difficult to identify with sonography and computed tomography.

treatment

As long as the clamps do not cause any discomfort, they do not require any treatment.
In the event of complaints, depending on the prognosis, treatment is symptomatic or surgical. In the case of surgical treatment, there is always the problem of the renewed formation of adhesions.
If there is an ileus or there is a risk of it developing, an operation is indicated.

prophylaxis

Since abdominal surgery results in a relatively high number of complaints and complications due to the high rate of postoperative adhesions , avoiding excessive scarring is an important goal for the surgeon. Various methods are available for this:

  • Prefer minimally invasive interventions ( laparoscopy instead of laparotomy )
  • adequate moistening of the mucous membranes during an operation
  • Avoiding the chafing effect when using swabs and cloths
  • Use of powder-free gloves
  • Minimization of injuries to the serosa
  • Avoidance of foreign bodies
  • Avoidance of remaining blood clots
  • Adequate but not excessive and necrotizing hemostasis
  • In high-risk operations, and patients has the possibility of application of drug adjuvants

literature

Individual evidence

  1. ^ A b Eugene Hardin et al: http://www.emedicinehealth.com/adhesions_general_and_after_surgery/article_em.htm , eMedicineHealth, by WebMD
  2. ↑ D. Brüggmann et al .: Intra-abdominal adhesions: definition, origin, importance in surgical medicine and possibilities of reduction. Dtsch Arztebl Int 2010; 107 (44): 769-75 doi : 10.3238 / arztebl.2010.0769 , outlook
  3. ↑ cf. D. Brüggmann et al .: Intra-abdominal adhesions: definition, origin, importance in operative medicine and possibilities of reduction. Dtsch Arztebl Int 2010; 107 (44): 769-75 doi : 10.3238 / arztebl.2010.0769 , prevention of postoperative adhesions