Postoperative adhesions are a significant yet often overlooked complication of surgery. Understanding what adhesions are, how they form, and the potential complications they can cause is crucial for both healthcare professionals and patients. This article explores the science behind adhesions and why preventing them matters.
What is Adhesion?
Adhesion refers to the formation of abnormal connections between tissues or organs that are normally separate. After surgery, the body's natural healing process can lead to the deposition of fibrous connective tissue around the surgical site. These fibrous adhesions may cause tissues or organs to stick together, impairing their normal function and sometimes resulting in severe complications.
How Do Adhesions Form?
The formation of adhesions is a complex process involving several biological events:
Trauma and Tissue Damage
Surgery or injury can damage tissues, triggering a cascade of healing responses.
Inflammatory Response
Increased vascular permeability induces inflammation, with the involvement of stromal mast cells, histamine, kinin, vasoactive substances, oxidative stress, and free radicals.
Fibrin Precipitation
Fibrin, a protein essential for clot formation, is deposited along with white blood cells and macrophages.
Imbalance in Fibrinolytic System
Normally, the fibrinolytic system dissolves excess fibrin. A decrease in its activity disrupts the balance, allowing fibrin to accumulate.
Fibroblast Invasion and Vascularization
Fibroblast cells and new blood vessels invade the fibrin matrix, forming permanent adhesions.
This multi-step process explains why adhesions can form rapidly after surgery, sometimes within hours.
Common Locations of Adhesions
Adhesions can occur in various parts of the body, with the most frequent sites including:
Abdominal cavity: intestines, liver, stomach, and other organs
Pelvic region: uterus, fallopian tubes, ovaries
Tendons and joints
Spine and spinal nerves
The incidence of adhesions is high: 67–93% after general abdominal surgery and up to 97% following open gynecologic pelvic procedures Liakakos et al., 2001.
Complications of Adhesions
Adhesions are more than a minor postoperative inconvenience-they can lead to serious medical conditions.
Abdominal Adhesions
Abdominal adhesions may cause internal organs to attach to the surgical site or to each other. This can result in twisting or stretching of organs, leading to complications such as abdominal pain or intestinal obstruction.
Pelvic Adhesions
In the pelvic region, adhesions often affect reproductive organs. Besides surgery, conditions like endometriosis and pelvic inflammatory disease are common causes.
Small Bowel Obstruction (SBO)
One of the most severe complications is SBO, where adhesions pull or kink the small intestine, blocking digestive flow. SBO requires immediate medical attention; untreated cases can be fatal. In the United States, SBO accounts for approximately 300,000–350,000 hospitalizations and about 30,000 deaths annually, with 65–75% caused by adhesive disease Reddy & Cappell, 2017; Ray et al., 1998.
Why Prevention Matters
Given the high prevalence and potential severity of adhesions, prevention is key. Effective strategies can include meticulous surgical techniques and the use of medical products designed to reduce postoperative adhesion formation, such as anti-adhesion gels and barriers. For example, products like Singclean's Surgical Anti-Adhesion Gel provide a physical barrier that prevents tissues from sticking together during the critical healing period, minimizing the risk of complications and improving patient outcomes.
Treatment of Postoperative Adhesions
Managing postoperative adhesions often requires a combination of surgical and non-surgical approaches. In severe cases where adhesions cause complications like bowel obstruction or chronic pain, adhesiolysis (surgical removal of adhesions) may be necessary. However, surgery itself can trigger new adhesion formation, making prevention during the initial operation critical.
One effective strategy is the use of anti-adhesion barriers and gels. Products such as Singclean's Surgical Anti-Adhesion Gel act as a temporary physical barrier between tissues, preventing abnormal fibrous connections while the body heals. These gels are easy to apply, biocompatible, and gradually absorbed by the body, reducing the risk of adhesions and improving postoperative recovery.
References:
Liakakos T., Thomakos N., Fine P.M., Dervenis C., Young R.L. Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance. Dig. Surg. 2001;18:260–273.
Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017;19(6):28.
Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186(1):1-9.