What are abdominal adhesions?
Abdominal adhesions are internal ‘scars’ that can bind between abdominal tissues and organ surfaces.1 The virgin abdomen contains cavities with fluid separating the interior wall of the abdomen, diaphragm and pelvis from the abdominal viscera and organs.2 However, abdominal adhesions cause the abdominal walls and the organs to abnormally bind together.
What causes abdominal adhesions?
Abdominal surgery is the most common cause of abdominal adhesions. It is estimated that 55 to 94% of patients having open surgery are at risk of developing abdominal adhesions.3
Surgical procedures with the highest risk of adhesion formation include:4
- Cholecystectomy: This is the surgical removal of the gallbladder.
- Gastrectomy: This is a medical procedure where all or part of the stomach is surgically removed.
- Appendectomy: This is the surgical removal of the appendix
- Hysterectomy: This is a surgery to remove a woman's uterus
- Colectomy: This is a surgical procedure to remove all or part of the colon.
- Abdominoperineal resection: This is a surgery in which the anus, rectum, and sigmoid colon are removed.
- Abdominal vascular operations: This is a surgery to repair any blocked vessels in the abdomen area
Abdominal adhesions can also result from non-surgical insults including infections, inflammations, chemotherapy, radiation and malignancy that may damage tissues and induce abdominal adhesions.5
What are the symptoms of abdominal adhesions?
Even though abdominal adhesions are generally asymptomatic, they have the potential to cause a number of acute and chronic symptoms. The main patients’ symptoms include:
- Abdominal bloating
- Irregular bowel movements
- Abdominal pain
- Digestive problems
- Intestinal obstruction
In some cases, abdominal adhesions may involve female reproductive organs, leading to infertility and chronic pelvic pains.6
How are abdominal adhesions diagnosed?
By giving your medical history, your doctor can suspect an abdominal adhesion. However, no other clinical investigations or imaging techniques allow a trusting diagnosis.6
How are abdominal adhesions treated?
Since abdominal adhesions do not generally cause any symptom, treatment is not required. However, in severe cases where adhesions cause obstruction of the intestines or compass the reproductive system, a surgical intervention is required in order to relieve the obstruction. More surgery, however, carries the risk of additional adhesions, therefore reduction or prevention of adhesions should be every surgeon’s primary goal.6
How can abdominal adhesions be prevented?
Treatment of abdominal adhesion is difficult but its prevention remains the key. Different techniques and surgery strategies are being adopted to limit adhesions:
- Development of laparoscopic surgery where a fiber optic is inserted allowing to better view the organs in the abdomen resulted in less tissue damage and less abdominal adhesion than laparotomy. However, the laparoscopic technique is not always possible and does not guarantee absence of adhesion.5
- Use of anti-adhesive adjuvants is becoming a very common and modern approach. It consists in using a barrier (gel, oils and films) between damaged organs in efforts to reduce abdominal adhesions.7
In summary, general strategies for preventing adhesions are becoming more and more developed and available and should be integrated into routine clinical practice.
- Okabayashi, Koji, et al. "Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity." Surgery today 44.3 (2014): 405-420.
- Beyene, Robel T., Sandra L. Kavalukas, and Adrian Barbul. "Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment." Current problems in surgery 52.7 (2015): 271-319.
- Drollette, Christina M., and S. Z. Badawy. "Pathophysiology of pelvic adhesions. Modern trends in preventing infertility." The Journal of reproductive medicine 37.2 (1992): 107-21.
- Liakakos, Theodoros, et al. "Peritoneal adhesions: etiology, pathophysiology, and clinical significance." Digestive surgery 18.4 (2001): 260-273.
- Kamel, Remah M. "Prevention of postoperative peritoneal adhesions." European Journal of Obstetrics & Gynecology and Reproductive Biology 150.2 (2010): 111-118.
- Brüggmann, Dörthe, et al. "Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options." Deutsches Ärzteblatt International 107.44 (2010): 769.
- Maciver, Allison H., Michael McCall, and AM James Shapiro. "Intra-abdominal adhesions: cellular mechanisms and strategies for prevention." International Journal of Surgery 9.8 (2011): 589-594.