From the Guidelines
Adhesions are abnormal fibrotic bands that form between tissues and organs, causing them to stick together abnormally, as a result of a pathological healing response of the peritoneum upon injury, as defined by the World Society of Emergency Surgery 1.
Definition and Causes
Adhesions are bands of scar tissue that can develop after surgery, particularly abdominal or pelvic procedures, but can also result from inflammation, infection, or trauma, as noted in the Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO) 1.
- They can cause tissues and organs to stick together abnormally, leading to various symptoms depending on the location of the adhesions.
- The formation of adhesions is a natural part of the body's healing process, as the body produces fibrin to repair damaged tissue, but sometimes this process becomes excessive, leading to problematic adhesions.
Symptoms and Complications
Symptoms of adhesions can vary depending on the location but may include:
- Chronic pain
- Bowel obstruction
- Fertility issues
- Difficulty with movement As reported by the World Journal of Emergency Surgery, adhesive small bowel obstruction (ASBO) is a common condition that can cause significant harm, resulting in hospitalization and mortality 1.
- ASBO can lead to complications such as bowel obstruction, which can require surgical intervention, and can result in significant morbidity and mortality.
Prevention and Treatment
Prevention strategies for adhesions include minimally invasive surgical techniques, careful tissue handling, anti-adhesion barriers placed during surgery, and proper post-operative care, as recommended by the Bologna guidelines 1.
- Treatment typically involves surgical removal (adhesiolysis) when adhesions cause significant problems.
- Non-operative treatment is effective in most patients with ASBO, and contraindications for non-operative treatment include peritonitis, strangulation, and ischemia, as noted in the guidelines 1.
- Physical therapy and pain management may help manage symptoms in less severe cases. Early intervention for symptoms like persistent pain or signs of bowel obstruction is important to prevent complications from adhesions, and the use of CT scans can help diagnose ASBO and guide treatment decisions 1.
From the Research
Definition and Formation of Adhesions
- Adhesions are abnormal fibrotic bands that occur when two tissues that normally move freely past each other attach via a fibrous bridge 2
- They are a natural consequence of tissue trauma and healing, and can be found after virtually every abdominopelvic operation 3
- Adhesions can be completely asymptomatic or can cause significant morbidity and mortality, including strangulation, obstruction, and necrosis of bowel loops and/or infertility and organ injury during repeat abdominal surgery 3
Clinical Implications of Adhesions
- Adhesions are a major health care burden, and their reduction is a significant unmet need in surgical therapeutics facing all surgeons 3
- They can cause postoperative pain, bowel obstruction, infertility, as well as complications with future procedures 4
- Adhesions can also lead to additional surgery to resolve adhesion-related complications, resulting in significant social and economic concerns 5
Prevention and Reduction of Adhesions
- Several agents have been developed to prevent adhesion formation, such as barriers, anti-inflammatory and fibrinolytic agents 4
- The Food and Drug Administration (FDA) has approved the use of physical barrier agents, but they have been associated with conflicting clinical studies and controversy in the clinical utilization of anti-adhesion barriers 4
- Current evidence suggests that the use of ORC, e-PTFE, HA-CMC, or 4% icodextrin is justified, but their use should not replace good surgical techniques 5
- Emerging therapies, such as gene therapy and stem cell-based approaches, may offer new strategies for preventing adhesion formation 4