What are adhesions and why are they a problem?
Adhesions are fibrous bands connecting structures that are normally separate. They develop as normal tissue responds to some form of injury. Adhesions can lead to a variety of complications, which include pelvic pain, infertility and bowel obstruction.
Why do adhesions form?
Some of the causes of adhesion formation are: Trauma -- Trauma is frequently a major contributor to the formation of adhesions. It has been shown that adhesions that form after surgery are a result of the body’s normal healing process.
Ischemia -- During surgery, blood flow often must be disrupted by cutting, coagulation or tying of sutures. This disruption can result in ischemia, or lack of blood supply. This can also lead to inflammation and cause adhesions to form.
Foreign bodies -- Foreign bodies can also cause an inflammatory reaction in the body. A foreign body can be suture material, lint from sponges, or talc from surgical gloves. Local cells respond to the foreign body by releasing factors that incite an inflammatory reaction which may result in adhesions.
Hemorrhage -- Hemorrhage brings blood products into the operating field. The raw surfaces from the operation plus the blood from tissues can enhance the formation of adhesions.
Infection -- Infection from a variety of sources, endometriosis or pelvic inflammatory disease can cause inflammation, which can result in adhesion formation.
Where do adhesions form?
Adhesions are common and can form on any surface in the pelvis and abdomen after surgery. Some organs, though, are more likely than others to develop adhesions. The ovary, pelvic sidewall and fimbria are the most common sites for adhesion formation. A study found that adhesions formed 55% of the time following surgery to the ovary, 40% of the time following surgery to the pelvic sidewall, and 36% of the time following surgery to the fimbria.
What can be done to prevent adhesions?
Microsurgical techniques -- Surgeons have developed microsurgical techniques that minimize trauma, ischemia, foreign bodies, hemorrhage, raw surfaces and infection to reduce adhesion formation.
Chemical Methods -- Various drugs have been evaluated in an effort to reduce the post-operative incidence of adhesions. To date, no well-controlled study has documented the efficacy of these drugs.
Barrier Methods -- The use of a barrier between raw tissue surfaces appears to be one of the most promising methods of adhesion prevention. Barriers mechanically separate the surgical surfaces and keep those surfaces apart.
Normally, the stomach, much of the intestines, and some other organs such as parts of the female reproductive system are able to slip and slide in relation to each other. This relative movement is facilitated by the organs and the inside of the abdominal wall being covered with a shiny membrane called the peritoneum. There is a film of fluid between adjacent layers of peritoneum - the peritoneal fluid - and this also lubricates the relative movement. The freedom to move helps normal functions such as the process of digestion, enabling waves of muscular contraction to pass along the gut wall and propel the food within the lumen.
Sometimes, however, parts of the peritoneum become "stuck together", and this can interfere with normal function. The problem arises when areas of peritoneum are damaged - either by accidental injury, during an operation, or as a result of infection - and become inflamed. When it is inflamed, the peritoneum becomes "sticky" and attaches itself to other areas of peritoneum. This may be a transient attachment, followed after a few days by separation, or it may become a permanent adhesion complete with fibrous scar tissue. The formation of adhesions can interfere with normal functions, and may lead to pain, intestinal obstruction, and infertility.
Adhesions occur in response to peritoneal injury. Most adhesions are the result of procedures such as handling and incisions made during abdominal surgery. Postsurgical adhesions can occur following virtually all types of surgery, resulting in serious clinical complications. Adhesions may cause intestinal obstruction or pain and infertility following general abdominal or gynecologic surgery. Such complications may require secondary surgical intervention, which is not only time consuming and costly but increases the potential for further complications. Therefore, prevention of adhesions is an important goal of surgical practice.