Abdominal Adhesions: High Risk Surgeries

The National Digestive Diseases Information Clearinghouse reports that almost every patient who has abdominal or pelvic surgery experiences adhesions, or the formation of abnormal strands of scar tissue that bind internal organs together. The risk of adhesion formation during gynecological procedures may be even higher than the risks involved with abdominal surgeries.

Many of these patients may never experience symptoms. Patients who do have abdominal or pelvic pain, vomiting, bloating, severe gas or other symptoms related to adhesions may be misdiagnosed. Because these internal scars cannot be detected by X-rays, CT scans, barium studies or other common diagnostic exams, doctors may attribute adhesion pain to Irritable Bowel Syndrome, Inflammatory Bowel Disease, endometriosis or diverticulitis. When left undiagnosed and untreated, adhesions may lead to serious complications, such as small bowel obstruction and female infertility.

Adhesions occur most frequently after surgeries of the bowel and the female reproductive organs. The organs responsible for digestion and reproduction are wrapped in a slippery coating, or membrane. Under normal circumstances, the membrane’s slick surface prevents organs from binding together. Adhesions are formed whenever a membranous coating is injured, when an internal infection occurs or when incisions are made and organs are handled or irrigated during surgeries. Contact with gauze, gloves, sponges, sutures and other surgical materials may cause bands of tissue to form in the internal organs after surgery.

Surgeries that often result in adhesions include, but are not limited to, surgery to remove ovarian cysts, surgeries to remove abnormal tissue in endometriosis, removal of uterine fibroids (myomectomy), hysterectomy, C-section and reconstruction or repair of the fallopian tubes. Even adhesiolysis, or the surgical removal of adhesions, may result in further adhesions.

Many of the open surgeries that women undergo could be performed by laparoscopy, or the use of a small camera connected to a video screen to visualize and perform procedures. Laparoscopy may pose a lower risk of adhesions than laparotomy, or open abdominal surgery, according to the National Institues of Health. Proper operative techniques and the use of barrier materials to keep organ surfaces separate during surgery may reduce the risk of adhesion formation. Surgeons have a professional responsibility to stay informed of the most effective techniques and materials for preventing adhesions and to implement these methods in their practice.

Patients who suffer from adhesions may search for years to find the cause of abdominal cramps, digestive discomfort, pelvic pain or infertility. Meanwhile, the risk of small bowel obstruction or other severe complications grows. Misdiagnosis of adhesion-related symptoms by medical professionals prolongs the pain and increases the risk of life-threatening complications.

Sources

National Digestive Diseases Information Clearinghouse: Abdominal Adhesions; January 2009. http://digestive.niddk.nih.gov/ddiseases/pubs/intestinaladhesions/#abdominal

National Institutes of Health: MedlinePlus: Adhesion. http://www.nlm.nih.gov/medlineplus/ency/article/001493.htm