What is Adhesiolysis (Lysis of Adhesions)?
Adhesiolysis is the surgical release of fibrous tissue bands (adhesions) that abnormally connect organs or surfaces within the peritoneal cavity, performed using either blunt or sharp dissection techniques during open or laparoscopic surgery. 1
Definition and Pathophysiology
Adhesions are fibrous tissue bands that connect surfaces or organs within the peritoneal cavity that are normally separated, representing a pathological healing response of the peritoneum following injury rather than normal tissue repair. 1
Common Causes of Adhesion Formation
- Previous abdominal surgery (the most common cause, occurring in 67-93% of cases) 2
- Radiotherapy 1
- Endometriosis 1
- Inflammation 1
- Local response to tumors 1
- Congenital adhesions (in patients with virgin abdomen) 1
Clinical Indications for Adhesiolysis
Primary Indications
- Small bowel obstruction caused by adhesions (adhesions account for 60-75% of all small bowel obstructions) 1, 3
- Failed non-operative management of bowel obstruction 3
- Complete bowel obstruction 3
Secondary Indications
- Adhesiolysis performed during reoperations for other indications to obtain sufficient access to the operative field 1
- Chronic abdominal pain (controversial indication with limited guideline support) 4
Surgical Techniques
Laparoscopic Approach
Laparoscopic adhesiolysis offers potential advantages including reduced postoperative pain, earlier return of bowel function, and shorter hospital stays compared to open surgery. 4, 2
- Operative times range from 58-108 minutes 2
- Conversion rates range from 6.7%-43% 2
- Length of hospitalization typically 4-6 days 2
- May modestly reduce future adhesion formation (OR 0.62) 5
Open Approach
- Traditional method via laparotomy 2
- 63% of laparotomy incision length becomes involved in adhesion formation to the abdominal wall 2
- Ventral hernia incidence ranges 11-20% (compared to 0.02-2.4% port site herniation with laparoscopy) 2
Complications of Adhesiolysis
Bowel Injuries (Complicated Adhesiolysis)
Iatrogenic bowel injuries are the most frequent complication during adhesiolysis, classified as: 1, 4
- Seromuscular injury: Injury to visceral peritoneum and smooth muscle layer without visible lumen or bowel content leakage 1
- Enterotomy: Full-thickness injury with visible mucous layer, lumen, or leakage of intestinal contents 1
- Delayed diagnosed perforation: Unrecognized bowel injuries that cause postoperative deterioration after abdominal closure 1
Complication Rates
- Bowel injury rates range from 6.3-26.9% in laparoscopic adhesiolysis, which is higher than open surgery 4
- Intraoperative enterotomy occurs in 3-17.6% of cases 2
Clinical Outcomes
Success Rates
- Long-term success rate of laparoscopic adhesiolysis ranges between 46-87% 2
- Non-operative management is safe and efficacious in 70% of adhesive small bowel obstructions 1
Recurrence
Recurrence of adhesions and obstruction is common regardless of surgical approach, requiring ongoing monitoring: 4, 3
- 12% of non-operatively treated patients are readmitted within 1 year 1
- 20% readmission rate after 5 years 1
Key Clinical Caveats
- The role of adhesiolysis for chronic abdominal pain remains controversial, with guidelines limiting scope to acute bowel obstructions rather than chronic pain management 4
- Laparoscopic adhesiolysis should be performed by well-trained, advanced laparoscopic surgeons 2
- Dense adhesions may necessitate conversion to open surgery 2, 6
- Risk of small bowel obstruction is highest following colorectal, oncologic gynecological, or pediatric surgery 1