Causes of adhesions

What are the causes of adhesions in gynecological and abdominal surgery?

Adhesions may form as the result of the following common gynaecologic procedures: 

Ovarian Surgery:
The ovary is the most common site for adhesions to form, usually resulting from surgery to remove ovarian cysts. 

Surgical Treatment of Endometriosis:
Endometriosis is a disease in which patches of endometrial tissue – the mucous membrane that lines the inside of the uterus – become implanted outside the uterus. Endometriosis often occurs in the pelvis and abdomen and can be associated with severe inflammation and dense adhesions. The abnormal tissue is removed through surgery. 

Myomectomy is the removal of fibroids from the uterus. Adhesion formation at the incision line on the uterus is a common complication of the procedure. 

Adhesiolysis is the removal or surgical separation of adhesions. Ironically, the removal of adhesions can aggravate the healing process, thereby leading to the formation of new adhesions. 

Reconstructive Tubal Surgery: 
The repair of blocked fallopian tubes is a delicate procedure that often includes the removal of existing adhesions. Unfortunately, the surgery itself can lead to the formation of new adhesions. 

Adhesions also are a common occurrence in women who suffer from pelvic inflammatory disease (PID) and sexually transmitted diseases. 

Factors that contribute to the cause of adhesions include the following:

The healing process from surgery is a major contributor to adhesion formation. 

During surgery, blood flow is often disrupted as a result of tissue cutting, blood clotting or tying of stitches. This may result in ischemia, or reduction of blood flow to the tissues, therefore contributing to adhesion formation. 

Foreign Bodies: 
Foreign bodies include stitches, lint from sponges or talc from surgical gloves. Foreign bodies can cause an inflammatory reaction in the body and can trigger adhesion formation. 

Endometriosis and PID can cause inflammation, which can result in adhesion formation. 

Adhesions following abdominal surgery

Abdominal surgeries that could lead to adhesions include 

  • colectomy,
  • hernia repair
  • adhesiolysis for bowel obstruction.
  • Appendectomy
  • Cholecystectomy
  • Cancer surgery
  • Liver and spleen surgery

Adhesions have been documented to occur in up to 94% of patients after major abdominal surgery