What Are Adhesions?

Adhesions are a type of scar tissue that may form between organs and tissues after many types of surgical procedures. This scar tissue forms as a result of injury to organs and tissues during surgery. These injuries are typically caused by suturing, cauterization, and abrading tissues and organs during surgery.

When tissue is injured, the area becomes inflamed. The body responds by depositing a substance at the injury site called fibrin. Fibrin can act like glue between the injury site and nearby tissues, causing them to stick together. Normally, as the body heals, the fibrin dissolves and is replaced with normal tissue. In some cases, however, decreased blood flow to the injured tissue prevents the fibrin from dissolving. The result is an internal scar, also called an adhesion.¹

Adhesions are a common result of surgery. In fact up to 93% of patients develop adhesions following open abdominal surgery², and up to 95% after open pelvic surgery.³ Some adhesions do not cause problems. But adhesions that prevent tissues and organs from moving freely can become a health issue, causing the affected tissues and organs to become twisted or pulled from their normal positions.

This internal trauma can cause future complications such as small bowel obstruction⁴, infertility³, and chronic pelvic pain.⁵  Adhesions can also make future surgery more difficult for your surgeon⁶, and may limit your candidacy for future treatment options such as laparoscopy⁷, certain types of chemotherapy⁷, and radiotherapy.⁸

Although not all adhesions cause problems, once formed, adhesions can’t be removed without surgery. This means that adhesions that form in one surgery may require future surgery just to cut through them in an attempt to alleviate pain, infertility or other complications.

Techniques for reducing adhesions

Doctors use a number of techniques to help prevent postoperative  adhesions. These include:

• Handling internal tissues with absolute care
• Using powder-free surgical gloves
• Controlling bleeding
• Choosing the appropriate sutures and implants
• Keeping tissues moist

However, even the most skilled doctors using the best methods may not be able to avoid adhesion formation without the aid of an adhesion barrier such as SEPRAFILM®.

Laparoscopy An operation that opens up the abdomen. Full glossary

Cauterization A technique used to stop bleeding that involves applying a hot instrument, electrical current, or chemical substance directly to tissue. Full glossary

Radiotherapy The treatment of disease by radiation (such as X-rays); also called radiation therapy. Full glossary

Infertility The inability to become pregnant. Full glossary

Fibrin An insoluble, fibrous protein formed in the clotting of blood. Fibrin may act like glue between tissues. Full glossary

Adhesions Internal scars that may form after surgery on or between internal organs and/or body tissue. Adhesions between tissues can twist and pull organs out of their normal places. Full glossary

1. Scott-Coombes, D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolytic response to elective surgery. Br J Surg 1995;82(3):414-7.

 

2. Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl. 1990;72:60-63.

 

3. DiZerega GS. Peritoneal repair and postsurgical adhesion formation. In Management of Common Problems in Obstetrics & Gynecology. Mishell DR, Goodwin Murphy T, Brenner PF, eds.;Blackwell Publishing; 2002; p.267-271.

 

3. DiZerega GS. Peritoneal repair and postsurgical adhesion formation. In Management of Common Problems in Obstetrics & Gynecology. Mishell DR, Goodwin Murphy T, Brenner PF, eds.;Blackwell Publishing; 2002; p.267-271.

 

4. Ellis H, Moran B, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476-1480.

 

5. Keltz MD, Gera PS, Olive DL.  Prospective randomized trial of right-sided paracolic adhesiolysis for chronic pelvic pain.  JSLS 2006;10(4):443-6.

 

6. Van der Krabben AA, Dijkstra FR, Newuwenhuijzen M, Reijnen MMPJ, Schaapvelt M, van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87:467-471.

 

7. Nichols DH, Clarke-Pearson DL, eds. Gynecologic, Obstetric, and Related Surgery. 2^nd ed. St. Louis, MO: Mosby, Inc; 1993.

 

7. Nichols DH, Clarke-Pearson DL, eds. Gynecologic, Obstetric, and Related Surgery. 2^nd ed. St. Louis, MO: Mosby, Inc; 1993.

 

8. Eifel PF.  Radiation therapy. In: Berek JS, Hacker NF, editors. Practical Gynecologic Oncology, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: 119-161.