Adhesions are internal scars -- strand-like fibrous tissue -- that form an abnormal bond between two parts of the body after trauma through complex processes involving injured tissues. For most patients, adhesions formation has little effect. However for some patients adhesions can cause severe clinical consequences: adhesion related disorder.
Surgery is the most common cause of adhesions, though infection, endometriosis, chemotherapy, radiation and cancer may also damage tissue and initiate adhesions.
Adhesions are almost an inevitable outcome of surgery and the problems that they cause are widespread and sometimes severe. Adhesions are the single most common and costly problem related to surgery and yet most people have not even heard of them. This lack of awareness means that many doctors are unable or unwilling to tackle the problems of adhesions.
Intestinal obstruction is one of the most severe consequences of adhesions. 30-41% of patients who require abdominal reoperation have adhesion-related intestinal obstruction. Adhesions involving the bowel can cause a bowel obstruction or blockage. Adhesions can also form elsewhere after surgery, such as around the heart, spine and in the hand where they may lead to other problems.
It is not unusual for several organs to be adhered to each other causing traction (pulling) of nerves. Nerve endings may also become entrapped within a developing adhesion causing severe pain. Adhesions involving the female reproductive organs can cause dyspaareunia (painful intercourse) infertility, subsequent surgery and debilitating pelvic pain.
Surgical procedures most commonly associated with adhesion formation are, ovarian cystectomy, myomectomy, total abdominal hysterectomy, salpingostomy / fimbrioplasty, excision of endometriosis, excision of eptopic pregnancy, cesarean section and adhesiolysis.
Following reproductive pelvic surgery performed by laparotomy, 55% to 100% of patients are shown to have adhesions at subsequent surgeries. The number of hospital readmissions for adhesion related complications rival the number of operations for heart bypass, hip replacements and appendix operations.
Over 40% of all infertility problems are related to adhesions.
This risk of developing adhesions and the severity increased with age and increasing number of previous laparotomies. A study involveing 120 patients undergoing reoperative laparotomy, estimated an increase of 24 minutes in total time of operation, because of intra-abdominal adhesions from a previous surgery. A 21% risk of adhesion- related bowel perforation was identified in 274 patients undergoing relaparotomy.
The rate of adhesion formation after surgery is surprising, given the lack of knowledge about adhesions, among doctors and patients alike. The lack of epidemiological data on adhesions, combined with an inability effectively to prevent adhesion formation has limited the impetus to investigate this disorder.