Postoperative adhesions were first documented in 1872, when Thomas Bryant reported a fatality due to adhesion-related bowel obstruction after gynecologic surgery.¹ Over the next 130 years, adhesions have maintained prominence in the medical literature, both as a study topic and as a factor influencing various treatments and outcomes. Health care providers often consider only a few of the ways adhesions impact surgery and patient care. There are many reasons to prevent adhesions. What follows is a summary of the impact of adhesions on abdominal and pelvic surgery.

Adhesions may increase the complexity of subsequent surgery
From cases with adhesions formed to prior incisions and surgical sites to those commonly referred to as “concrete abdomen,” postoperative adhesions may increase the risk of inadvertent injury and complications during abdominal surgery. Perhaps the most dreaded is inadvertent enterotomy. A recent study documented a 19% rate of adhesion-related enterotomy during subsequent or reoperative surgery.² In this study, patients with adhesion-related enterotomy had significantly higher post-operative complications (leaks, wound infections, hemorrhages) and increased length of stay.

Adhesions from previous surgery may increase the length of an operation
Spending extra operating time to lyse adhesions is common in abdominopelvic surgery, and may impact both the patient’s length of stay and operating room scheduling. A recent study documented that an average of 15 additional minutes were required to perform an incision on a patient who had a prior surgery, and up to 3 hours to perform the incision, due to adhesions from a prior surgery. ³

Adhesions can account for 49%-74% of small bowel obstructions⁴
Small bowel obstruction is a serious consequence of abdominal and pelvic surgery. It is well documented in the medical literature that adhesions are a primary cause of intestinal obstruction. Between 49% and 74% of intestinal obstructions can be due to adhesions.

Adhesions can account for 15%-20% of infertility cases⁴
There are many causes of infertility in women, including adhesions. With this important complication in mind, surgeons routinely use methods to reduce postoperative adhesions in open pelvic procedures. The uterus and ovaries can be protected from adhesions by the use of approved adhesion barriers following open abdominopelvic surgery.

Adhesions can account for 20%-50% of chronic pelvic pain cases⁵
Perhaps the most controversial topic surrounding adhesions is the syndrome of chronic pelvic pain. Adhesions have been implicated in up to 50% of chronic pelvic pain cases. Recent studies show that adhesions themselves contain sensory nerve fibers and may be capable of transmitting pain.

Adhesions can impact options for future management of patients⁵
Adhesions compartmentalize the abdomen and may complicate the adequate distribution of intraperitoneal therapeutics. Nonspecific gastrointestinal complications may also be related to adhesions.

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References

1. Bryant T. Clinical lectures on intestinal obstruction. Med Tim Gaz. 1872;1:363-5.

2. Van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MMPJ, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000; 87;467-471.

3. Beck DE, Ferguson MA, Opelka FG, Fleshman JW, Gervaz P, Wexner SD. Effect of Previous Surgery on Abdominal Opening Time. Dis Colon Rectum. 2000;43(12);1749-1753.

4. Ray NF, Denton WG, Thamer M, Hernderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the U.S. in 1994. J Am Coll Surg. 1998;186(1);1-9.

5. Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynec. 1994;170(5);1396-1403.