What Are Adhesions?

Adhesions are bands of scar tissue that can form inside the body following surgery. This scar tissue binds together internal organs that are normally separated from each other.

Adhesions develop as a result of the injury organs and tissues sustain when they are cut, touched and handled during abdominal or pelvic surgery. Adhesions develop in approximately 95% of patients who have undergone major abdomeno-pelvic operations1 and affect the quality of life of millions of people.2

You can think of adhesions as a type of scab, like those that form when you cut your skin. The scab joins the two cut surfaces together, except adhesions are in between internal organs, rather than on the surface, of the body. Although adhesions formation is part of the natural healing process, they can lead to unwanted effects.

How are adhesions formed?

Adhesions form as a result of injury or trauma to the clear membrane (the peritoneum) that coats the major organs abdomen and pelvis.

When the peritoneum is healthy, it is slippery. When it is damaged, the body’s immune system starts to work to repair the damage and the site becomes inflamed. Inflammation is a normal part of the healing process, but it causes the development of fibrous bands of scar tissue (called a fibrin matrix). Normally these fibrin bands dissolve over time. Surgery can frequently decrease blood flow to the injured tissue and prevent the fibrin from dissolving. The result is an internal adhesion.

Although surgery is the most common cause of adhesions, they can also form as a result of:

• infection (e.g. appendicitis)
• gynacological conditions (e.g. endometriosis, ovarian cysts or ectopic pregnancies)
• foreign bodies (e.g. sutures and clips)
• radiation (e.g. such at that used to treat some cancers)

Left: normal peritoneum.

Right: after surgery fibrous bands grow as part of the normal healing process and form adhesions.

Adhesion types

Although adhesions can occur anywhere, the most common locations are the abdomen and pelvis.

Pelvic adhesions

Pelvic adhesions can affect any pelvic organ such as the uterus, ovaries, fallopian tubes and/or bladder.

Abdominal adhesions

Because the abdomen sits higher in the body than the pelvis, abdominal adhesions involve the liver, stomach, small and/or large intestines.

References

1. Ellis, H. Et al. (1999) ‘Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.’ The Lancet, vol. 353, pp. 1476– 480.
2. Llakakos, T. et al., (2001) ‘Peritoneal adhesions: etiology, pathophysiology, and clinical significance.’ Dig Surg, vol. 18, pp. 260–273.