ADHESION

OPERATIVE ADHESIOLYSIS
ADHESION PREVENTION
INCIDENCE

More than 90% of the patients following major

abdominal surgery
55-100% of the women undergoing pelvic surgery.

Small-bowel obstruction, infertility, chronic

abdominal and pelvic pain, and difficult re-operative
surgery are the most common consequences of
peritoneal adhesions.

Dig Surg. 2001;18(4):260-73.

PATHOPHISIOLOGY

PERITONEAL Semin Reprod Med. 2008;26(4):313-321.

INJURY

the normal mesothelial cells

overlaying the peritoneal
surface

histamines and kinins are released

the collection of a fibrin-rich exudate

RISK FACTORS

EPITHEL INJURY
ISCHAEMIA
BLOOD CLOTCH
FOREIGN BODY
NUTRITIONAL STATUS
TISSUE NECROSIS
BACTERIAL INFECTION
COMPLICATION

INFERTILITY
CHRONIC PELVIO-ABDOMINAL PAIN
BOWEL OBSTRUCTION
PREVENTION

Practical tips: general strategies for reduction

of adhesions*

Preference for tissue-sparing and microinvasive

surgical techniques
Minimization of operating time and of heat and light
Avoidance of peritoneal trauma by superfluous contact
and coagulation
Limited placement of intra-abdominal foreign bodies
such as patches, meshes, and suture material
Use of moistened abdominal drapes and swabs and
occasional application of saline solution to minimize
dehydration of mesothelial surfaces
Irrigation of the abdominal cavity to remove residual
intra-abdominal blood depots
Reduction of infection risk by ensuring sterile working
conditions and giving antibiotics as required
Laparotomy: preferential use of latex- and powder-free
gloves
Laparoscopy: use of humidified gases at appropriately
low insufflation pressure
High-risk patients: use of barrier techniques or
peritoneal instillates after appropriate explanation
Applying adhesion barriers during surgery can help
to prevent the formation of adhesions.
There are two methods that are approved by the
U.S. Food and Drug Administration (FDA) for
adhesion prevention: Intercede and Seprafilm.
One study found that Seprafilm is twice as effective
at preventing adhesion formation when compared to
just surgical technique alone.Surgical humidification
therapy may also minimise the incidence of
adhesion formation.[9] Laparoscopic surgery has a
reduced risk for creating adhesions
The widely used, commercially available
adjuvants licensed for use in Germany
include:

Humidified and warmed insufflation gases for

laparoscopy
Medicinal agents
Colloid and crystalloid solutions
Separators: fluids for peritoneal instillation or
site-specific mechanical barriers.
Abdominal adhesions
Abdominal adhesions (or intra-abdominal
adhesions) are most commonly caused by
abdominal surgical procedures. The adhesions
start to form within hours after surgery and
may cause internal organs to attach to the
surgical site or to other organs in the
abdominal cavity.
Adhesion-related twisting and pulling of
internal organs can result in complications
such as abdominal pain or intestinal
obstruction. Small bowel obstruction (SBO) is
a significant consequence of post-surgical
adhesions.
Pelvic adhesions
Pelvic adhesions are a form of abdominal
adhesions in the pelvis, typically in women
affecting reproductive organs and thus of
concern in reproduction or as a cause of
chronic pelvic pain.
A study in Digestive Surgery showed that
more than 90% of patients develop
adhesions following open abdominal surgery
and 55100% of women develop adhesions
following pelvic surgery

The omentum is particularly susceptible to

adhesion formation; one study found that
92% of post-operative adhesions were
found in the omentum
ADHESIOLYSIS

SURGICAL ANATOMY
FREE ADHESION SITE
IDENTIFICATION OF URETER, BOWEL
IDENTIFICATION OF BLOOD VESSEL