Attenuation of postoperative adhesions using a modeled manual therapy

Abstract

Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations. As such, they represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. We hypothesized that postoperative adhesions develop from a lack of movement of the abdominopelvic organs in the immediate postoperative period while rendered immobile by surgery and opiates, and tested whether manual therapy would prevent their development. In a modified rat cecal abrasion model, rats were allocated to receive treatment with manual therapy or not, and their resulting adhesions were quantified. We also characterized macrophage phenotype. In separate experiments we tested the safety of the treatment on a strictureplasty model, and also the efficacy of the treatment following adhesiolysis. We show that the treatment led to reduced frequency and size of cohesive adhesions, but not other types of adhesions, such as those involving intraperitoneal fatty structures. This effect was associated with a delay in the appearance of trophic macrophages. The treatment did not inhibit healing or induce undesirable complications following strictureplasty. Our results support that that maintained movements of damaged structures in the immediate postoperative period has potential to act as an effective preventive for attenuating cohesive postoperative adhesion development. Our findings lay the groundwork for further research, including mechanical and pharmacologic approaches to maintain movements during healing.

Influence of postoperative adhesions after caesarean section on chronic lower back pain – A pilot study of osteopathic manipulative treatment.

“…Group A, in which the focus lay on the adhesions, experienced a significant improvement in cLBP symptoms. Studies from Chapelle and Bove confirm that using visceral mobilisation, adhesions can be loosened [9] and the associated impact can be lessened [10]. Changes in the microstructure may lead to a modification of the macrostructure and allow the tissue to return to its physiological function [12].…”

“…Adhesions as postoperative complications are common in the medical field [1][2][3], and their widely varying effects on the rest of the body are often mentioned in the research [2,[4][5][6][7][8]. Various studies describe positive effects of postoperative scars on the body [11][12][13][14], but studies on the treatment of adhesions are hard to find [9,10]. The results of the pilot study suggest that postoperative adhesions could cause cLBP, since the treatment of adhesions showed a decrease in cLBP.…”

“…Manual therapy treatments for such adhesions are rarely found in existing research [9]. Chapelle and Bove dealt concretely with the visceral mobilisation of adhesions in studies with rats [9,10], while in one pilot study, Probst examined the influence of osteopathic treatment on postoperative recovery after a gastrointestinal operation [11]. Several case studies and studies show that treatment of postoperative scars can reduce individual pain [12][13][14].…”

Postoperative peritoneale Adhäsionen

“…Dennoch unterstützen bisherige Studienergebnisse die Annahme, dass das Mobilisieren der geschädigten Strukturen nach einer Operation präventiv der Entstehung von Adhäsionen entgegenwirkt und Fibrinbänder v. a. in den Anfangsstadien durchaus noch abreißbar bzw. veränderbar sind [7,14]. Studien zur manuellen Beeinflussung von peritonealen Adhäsionen sind rar.…”

Battling adhesions: from understanding to prevention

“…Some studies in abdominal surgery indicate that manual therapy could be beneficial for adhesion prevention after surgery. Recently, in an in vivo study, Bove et al showed that manual therapy after abdominal surgery attenuates the formation of adhesions in rats [122]. The authors suggested a mechanism similar to that in tendons; the motion of organs disrupts initially formed adhesions of deposited fibrin, preventing their settlement.…”