What is adhesion disease?

From the Guidelines

Adhesion disease is a common cause of small bowel obstruction, even in patients with a virgin abdomen, and its management should prioritize non-operative treatment, comprising bowel decompression, water-soluble contrast agents, and fluid resuscitation, as it has been found safe and efficacious in 70% of cases caused by adhesions 1. When considering the management of adhesion disease, particularly in the context of small bowel obstruction, it's crucial to understand that adhesions are the single most common cause of this condition, accounting for 60-75% of cases 1.

Key Points to Consider

• The majority of small bowel obstructions are now managed non-operatively, with a success rate of 70% in cases caused by adhesions 1.
• The assumption that small bowel obstruction in a virgin abdomen is usually caused by other etiologies than adhesions is being challenged by recent studies suggesting a high incidence of adhesions in these patients as well 1.
• The origin of adhesions in the virgin abdomen can be congenital or the result of unrecognized abdominal inflammation, highlighting the complexity of adhesion disease 1.
• Treatment guidelines for adhesion-related small bowel obstruction might also apply to the majority of patients with small bowel obstruction in a virgin abdomen, given the high incidence of adhesions in this group 1.

Management Approach

Given the recent evidence, a non-operative management approach should be considered first for adhesion disease, especially in cases of small bowel obstruction, unless there are clear indications for immediate surgical intervention, such as signs of bowel ischemia or perforation. This approach includes bowel decompression, the use of water-soluble contrast agents to assess bowel obstruction, and fluid resuscitation to manage any associated dehydration or electrolyte imbalances 1.

Prevention and Future Directions

Prevention strategies, such as the use of minimally invasive surgical techniques and anti-adhesion barriers during surgery, are crucial in reducing the formation of new adhesions 1. Further research is needed to better understand the etiology of adhesions in virgin abdomens and to develop more effective prevention and treatment strategies for adhesion disease.

From the Research

Definition and Prevalence of Adhesion Disease

• Adhesion disease, also known as adhesive disease, refers to the formation of intra-abdominal adhesions that lead to chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern 2.
• Postsurgical adhesion formation is a common complication associated with surgical procedures, and it can impact the patient's well-being and impose a financial burden due to medical expenses required for reoperative surgeries or adhesiolysis 3.

Causes and Risk Factors of Adhesion Disease

• Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes 2.
• Adhesions can be found after virtually every abdominopelvic operation performed through standard laparotomy as well as by laparoscopic approaches 4.
• The multifactorial nature of adhesion development makes prevention very limited 4.

Symptoms and Diagnosis of Adhesion Disease

• Adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic 2.
• There is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease 2.
• A validated, clinically relevant scale to assess intra-abdominal adhesions is needed to diagnose and treat adhesion disease effectively 4.

Treatment and Prevention of Adhesion Disease

• Current evidence suggests that the use of ORC, e-PTFE, HA-CMC, or 4% icodextrin is justified to reduce postsurgical adhesions 5.
• The use of adhesion-reducing agents, such as a synthetic, dual-polymer gel composed of carboxymethyl cellulose and poly(ethylene oxide), has demonstrated higher efficacy across a greater range of indications and surgical procedures 3.
• Emerging strategies, including precision and personalized medicine, are being developed to improve outcomes for patients and our healthcare system 6.
• Good surgical techniques, such as microsurgical principles and minimally invasive surgery, are recommended to reduce the formation of postsurgical adhesions 5.