Causes and Consequences of Adhesions

Adhesions the hidden illness, you may never have heard of it but this most distressing life altering condition will affect almost everyone who has surgery, in fact, 55% to 100% of patients are shown to have Adhesions at subsequent surgeries. Adhesions are quite common and can form on any surface in the pelvic region and abdomen after surgery. Some organs, though, are more likely than others to develop Adhesions. The ovary, pelvic sidewall and fimbria are the most common sites for Adhesion formation.

Adhesions and Adhesion related disorders (ARD) are one of the most common complications of surgery. Hospital admission for ARD rival those for heart bypass, appendix and other well known operations. Many people go their entire lives without problem, the complications of adhesions can strike at any time, even 50 years after your operation.

Adhesions are internal scars, strand like fibrous tissue that form an abnormal bond between two parts of the body after trauma, through complex processes involving injured tissues and the peritoneum. For most patients, Adhesions formation has little effect. However for some patients, Adhesions can cause severe clinical consequences. (ARD)

Adhesions usually occur in response to trauma, injury of various kinds and are an almost inevitable outcome of surgery, although this is not always the case. Any peritoneal injury can result in fibrous Adhesion formation. Adhesions have been found in patients undergoing first time surgery. For example, infection, endometriosis, chemotherapy, Radiation and cancer may damage tissue and initiate Adhesions.

The most common cause of Adhesion formation, is after surgery. Adhesions normally occur at the site of the surgical procedure. It has been shown that Adhesions that form after surgery are a result of the body's normal healing process. Adhesions frequently develop during the first three to five days after surgery.

Surgical procedures most commonly associated with Adhesion formation are, ovarian cystectomy, myomectomy, total abdominal hysterectomy, salpingostomy / fimbrioplasty, excision of endometriosis, excision of eptopic pregnancy, cesarean section, and adhesiolysis.

Following reproductive pelvic surgery performed by laparotomy, 55% to 100% of patients are shown to have Adhesions at subsequent surgeries. The number of hospital readmissions for Adhesion related complications rival the number of operations for heart bypass, hip replacements and appendix operations.

Adhesions involving the female reproductive organs, the ovaries, fallopian tubes, etc can cause dyspaareunia (painful intercourse) infertility, over 40% of all infertility problems are related to Adhesions, subsequent surgery, and debilitating pelvic pain.

It is not unusual for several organs to be adhered to each other causing traction (pulling) of nerves. Nerve endings may also become entrapped within a developing adhesion causing severe pain.

Intesttinal obstruction is one of the most scvere consequences of Adhesions. 30-41% of patients who require abdominal reoperation have Adhesion-related intestinal obstruction. Adhesions involving the bowel can cause a bowel obstruction or blockage. Adhesions can form elsewhere such as around the heart, spine and in the hand where they may lead to other problems. Adhesion related disorders (ARD)

For small-bowel obstruction, the proportion rises to 65-75°I0.7'' The clinical consequences of Adhesions are not confined to the gut; Adhesions are a leading cause of secondary infertility in women, and can cause substantial abdominal and pelvic pain.

The Magnitude of Adhesions in the UK

The rate of Adhesion formation after surgery is surprising, given the lack of knowledge about Adhesions, among doctors and patients alike. The lack of epidemiological data on Adhesions, combined with an inability effectively to prevent Adhesion formation has limited the impetus to investigate this disorder.

However validated data from the Scottish National Health Service medical record linkage database was used to identify patients undergoing open abdominal or pelvic surgery in 1986, who had no record of such surgery in the preceding 5 years. Patients were followed up for 10 years and subsequent readmissions were reviewed and outcomes classified by the degree of Adhesions. They also assessed the rate of Adhesion related admissions in 1994 for the population of 5 million people.

A study involveing 120 patients undergoing reoperative laparotomy, estimated an increase of 24 minutes in total time of operation, because of intra-abdominal Adhesions from a previous surgery. A 21% risk of Adhesion related bowel perforation was identified in 274 patients undergoing relaparotomy.

This risk of developing Adhesions and the severity increased with age and increasing number of previous laparotomies. Although these data confirm the role of postoperative Adhesions in morbidity anti mortality, no large epidemiological studies have assessed the scale of adhesion-related outcomes over time.

Adhesions are almost an inevitable outcome of surgery, and the problems that they cause are widespread and sometimes severe. It has been said by some that adhesions are the single most common and costly problem related to surgery, and yet most people have not even heard of them. This lack of awareness means that many doctors are unable or unwilling to tackle the problems of adhesions.

Adhesions and ARD are conditions that are not clearly recognised nor understood and for those who are suffering it is often a very lonely existence. There is a great need to raise the level of awareness among doctors, healthcare providers, government, and the public as a whole, to prompt a more comprehensive and integrated care system for ARD sufferers.

Patients suffering from Adhesions and Adhesion Related Disorders are often sentenced to the frustrating ordeal of having to find experienced and accessible healthcare for their condition. In addition they are often mislabeled as "psychiatric" cases and are isolated from family and friends.

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