Reduced chronic pain after abdominal surgery through new adhesion approach Adhesions detected with MRI video and prevented with layer of sugar

Less pain in eighty percent of patients, a three times lower risk of intestinal obstruction, and significantly fewer unnecessary surgeries. These are the results of a new combined approach to pain caused by adhesions in the abdomen after surgery. Medical researcher Barend van den Beukel from Radboud university medical center defended his doctoral thesis on these findings.

Approximately half of the people in the Netherlands experience abdominal surgery at some stage in their lives. Out of these individuals, ten percent end up experiencing chronic pain, often attributed to the formation of adhesions. Adhesions are strands of scar tissue that develop as a natural part of the healing process after surgery, leading to the sticking together of the intestines or their attachment to the abdominal wall.

Detecting these adhesions using standard scanning techniques poses a challenge. Additionally, these strands of scar tissue have the annoying tendency to regrow after a physician has separated them through surgical intervention. Improved diagnosis and treatment of adhesions are crucial and can benefit many individuals.

Video

Researchers at Radboudumc have developed a new approach to address these adhesions: a combination of an innovative MRI technique, forming the basis for clinical decisions, and the use of a fluid or soluble membrane, to reduce the chances of adhesions regrowing after separation. They tested their approach in a study involving 106 patients.

The MRI technique, known as cine-MRI, is relatively new. The scans were conducted at Rijnstate Hospital. ‘During a standard MRI scan, you lie still, making it difficult to see adhesions’, explains Barend van den Beukel, the doctoral candidate. ‘We have people move their abdomen during the scan and create a video. You can then see how the abdominal contents slide along the abdominal wall. Trained radiologists can see where something is stuck and therefore adhered in those moving images.’

Gel Layer

In about one in six scans in the study, no adhesions were visible. For these individuals, surgery is not beneficial as adhesions are not the cause of the pain, preventing unnecessary surgeries. Sometimes, another cause of the pain was found on the MRI scan for these individuals.

If adhesions were visible, surgery followed, and physicians used their second strategy: placing a barrier between the tissues they separated to prevent them from sticking together again. ‘There are two types of materials for this’, explains Van den Beukel. ‘One is a fluid with large sugar molecules. The other is a kind of soluble membrane made of sugar molecules that turns into a gel layer in the body. Both materials provide a protective layer between the intestines. The body clears the materials after a few weeks.’

Like a Garden Hose

With this new combined approach, eighty percent of patients experienced less pain after a year. They used fewer painkillers and reported an improved quality of life. Furthermore, the risk of intestinal obstruction was three times lower. Van den Beukel illustrates: ‘Such an obstruction occurs when a section of the intestine gets trapped behind a scar strand. You can compare it to a garden hose getting caught behind a fence, and then no water comes out.’

Radboudumc has a clinic for chronic abdominal complaints after surgery, where the combination of cine-MRI and barrier materials is applied. This method is also being adopted by more and more other hospitals, including MUMC+. Surgeon Richard ten Broek says: ‘Before we had cine-MRI, we performed exploratory surgeries on patients, but we found no cause of pain in twenty percent of cases. This has decreased to four percent. In addition, we see far fewer complications. We can now operate much more effectively for chronic abdominal complaints after previous surgeries.’

More information about this dissertation

Defense on December 20, 2023, at 10:30 a.m. by Barend van de Beukel. Dissertation title: Postoperative Adhesion Formation and Chronic Pain (available online after December 20). Supervisors: Prof. Dr. H. van Goor, co-supervisor: Dr. R.P.G. ten Broek. The defense can be followed via this livestream.

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