How I Do It — Prof. Dr. Ünal Aydın’s Gentle Warm-Water Adhesiolysis Technique скачать в хорошем качестве

How I Do It — Prof. Dr. Ünal Aydın’s Gentle Warm-Water Adhesiolysis Technique

Background: Postoperative intraabdominal adhesions are among the most formidable challenges faced by surgeons after abdominal operations. In certain patients, an exaggerated fibrin response—often driven by genetic or metabolic predisposition—leads to dense and tenacious adhesions. The bowel, which should normally move freely within the abdominal cavity, becomes entrapped in rigid fibrin bridges, predisposing to recurrent ileus and repeated reoperations. Each subsequent surgery increases the risk of bowel injury and morbidity, turning what begins as a correctable problem into a surgical impasse. Although several antifibrin and antiadhesive agents have been developed, their clinical efficacy is inconsistent and limited. Therefore, a method that can dissolve or release fibrin without mechanical trauma remains an unmet need in modern abdominal surgery. Technique: For nearly fifteen years, Prof. Dr. Ünal Aydın has refined and consistently applied a physiology-based intraoperative method known as the warm-water fibrin release technique. During surgery, the entire abdominal cavity is gently irrigated with sterile water heated to approximately 48°C — a temperature at which fibrin begins to denature and lose its tensile strength. Once the fibrin bridges soften, gentle dissection is carried out under continuous warm-water irrigation. This approach allows the adhesions to release gradually, minimizing serosal tears and preventing the reformation of new adhesions. Unlike traditional methods using electrocautery or sharp dissection, the warm-water technique relies on temperature-induced relaxation of protein bonds, enabling separation through natural tissue planes. The operation becomes more physiological, less traumatic, and notably bloodless. Findings and Observations: In cases of severe, long-standing adhesions — particularly those following multiple laparotomies — this method allows safe and controlled release without bowel perforation or full-thickness injury. The operative field remains clear and dry, bleeding is negligible, and the risk of postoperative complications such as leakage, sepsis, or re-adhesion is markedly reduced. The gentle tactile feedback experienced during warm-water dissection provides a unique sense of tissue compliance, allowing the surgeon to distinguish viable bowel from fibrotic or devitalized tissue. The accompanying video demonstrates one of these challenging cases, offering the first visual documentation of the technique’s effectiveness and its underlying physiological rationale. This approach embodies the principle that precision and patience can often outperform mechanical force in complex abdominal surgery. Conclusion: Although not yet supported by randomized clinical trials, the gentle warm-water adhesiolysis technique represents an innovative, reproducible, and atraumatic strategy for managing complex reoperative abdomens. It aligns surgical intelligence with biophysical understanding — utilizing temperature as a therapeutic instrument rather than a destructive force. This harmony between physiology and surgical art transforms the peril of dense adhesions into a calm, controlled, and harm-free process. The method serves not only as a technical innovation but also as a philosophical statement: that true surgical mastery lies in gentleness guided by knowledge. This video presents the first scientific documentation of the technique under the title: “How I Do It – Prof. Dr. Ünal Aydın’s Gentle Warm-Water Adhesiolysis Technique.”