Does lysis of adhesions cause abdominal pain?

Does Lysis of Adhesions Cause Abdominal Pain?

No, lysis of adhesions (adhesiolysis) does not cause chronic abdominal pain—rather, it is performed to treat adhesion-related pain, though the procedure itself causes typical postoperative pain that resolves, and the evidence for its efficacy in treating chronic pain remains controversial.

Understanding the Question Context

The question likely refers to whether the surgical procedure of adhesiolysis itself generates or perpetuates chronic abdominal pain, versus whether it treats existing adhesion-related pain. The evidence addresses both aspects 1.

Acute Postoperative Pain from the Procedure

• Adhesiolysis, like any surgical intervention, causes acute postoperative pain that is self-limited and resolves during normal recovery 1.
• Laparoscopic adhesiolysis may result in reduced postoperative pain compared to open surgery, with earlier return of bowel function and shorter hospital stays 1.
• The acute pain from the surgical intervention itself is distinct from chronic adhesion-related pain and follows typical postoperative pain trajectories 1.

Adhesiolysis as Treatment for Chronic Pain

Evidence Supporting Benefit

• Laparoscopic adhesiolysis can decrease adhesion-related chronic abdominal pain in selected patients, with studies showing 59-84% of patients experiencing complete pain relief or significant improvement 2, 3, 4.
• One study demonstrated statistically significant decreases in analog pain scores at 6,9, and 12 months postoperatively in patients with complex abdominal and pelvic pain syndrome (CAPPS) 2.
• The mechanism may involve more than simple cutting of scar tissue, potentially including resolution of "phantom pain"-like phenomena that takes time to resolve after surgery 2.

Evidence Showing Controversy

• The role of adhesiolysis for chronic abdominal pain remains controversial, with the World Society of Emergency Surgery guidelines explicitly stating this controversy and limiting their scope to acute bowel obstructions rather than chronic pain management 1.
• A systematic review found benefit ranging from 16-88% across studies, but identified high risk of bias in most non-randomized studies 5.
• Three randomized controlled trials showed inconsistent results: one showed benefit, one showed benefit only in patients with dense vascularized adhesions, and one showed no difference from control 5.
• Recent evidence (2023) suggests that elective adhesiolysis with adhesion barriers is effective in selected patients, with novel imaging techniques like cineMRI helping identify appropriate candidates 6.

Complications That May Cause Pain

• Iatrogenic bowel injuries during adhesiolysis can cause significant pain and morbidity, including seromuscular injuries, enterotomies, and delayed diagnosed perforations 1, 7.
• Bowel injury rates range from 6.3-26.9% in laparoscopic adhesiolysis for small bowel obstruction, which is higher than open surgery 1.
• Enterocutaneous fistulae and intraabdominal hematomas are documented perioperative complications that cause pain 4.

Clinical Algorithm for Decision-Making

When considering adhesiolysis for chronic pain:

• Exclude other causes of abdominal pain (irritable bowel syndrome, hernias, endometriosis, malignancy) through appropriate workup 4.
• Use advanced imaging (cineMRI) to identify patients where adhesiolysis is safe and effective 6.
• Select patients with dense, vascularized adhesions who are most likely to benefit 5.
• Consider laparoscopic approach to minimize additional adhesion formation and postoperative pain 1.
• Use adhesion barriers during surgery to reduce risk of recurrence 6.

Key Caveats

• The evidence for adhesiolysis treating chronic pain is insufficient to make definitive conclusions, despite promising preliminary results 5.
• Careful patient selection is critical—not all patients with adhesions and chronic pain will benefit from surgery 6, 5.
• Recurrence of adhesions and pain is common, requiring ongoing monitoring 7, 6.
• The procedure carries significant risks including bowel injury, particularly with laparoscopic approaches in complex cases 1.