Post-Surgical Adhesions: Are They Avoidable?
Post-surgical adhesion formation is the most common complication of abdominal or pelvic surgery.1 What’s more, any type of surgery at any site can cause post-surgical adhesions.2 But does that mean they are almost inevitable and what can be done to prevent them?2,3 Here, Rory Tippit MD, MPAS Medical Director- Americas Baxter Healthcare Corporation provides some answers.
Adhesions are fibrous bands that form between tissues and organs to create thin films of connective tissue, and they can develop into thick fibrous bands that are vascularized.3,6 Adhesions have several possible causes, including abdominal or pelvic surgery. During an operation, they result when natural healing processes occur in the proinflammatory and ischemic conditions created by surgery.3,7
It was thought that meticulous surgical technique could mitigate the risk of post-surgical adhesions.2 Yet, despite improvements in surgical technique, adhesions remain common and are observed after 50–95% of all operations.6 Indeed, the formation of adhesions is the most common post-surgical complication of abdominal or pelvic surgery.1
Up to 93%
of patients develop adhesions following one or more open abdominal operations4
of abdominal surgical patients will return for adhesion-related complications5
is the estimated annual economic impact of adhesiolysis procedures5
Moreover, we know that the consequences of adhesions can be both serious for patients1,8,9 and expensive for healthcare systems, mostly due to the need for second surgery to perform adhesiolysis.3,5 Some complications arising from post-surgical adhesions, such as chronic pain and secondary fertility, have lifelong clinical consequences for patients and this can have an enormous emotional toll.1,8,10 Therefore, it’s important that we acknowledge the significance of adhesions and consider what can be done to reduce the incidence.
The burden of adhesions is not only felt by patients – increased hospitalization, longer operative times and longer length of hospital stay, as well as the need for adhesiolysis, all add up to billions of dollars for healthcare providers each year.5,6
Unfortunately, it can be easy to overlook these complications because they tend to be treated by someone other than the surgeon who conducted the first operation.11 What’s more, adhesion-related complications occur unpredictably and may remain asymptomatic for several years after a procedure.11 These challenges in the post-surgical period make it clear that the optimum time for intervention is before surgery and before adhesions have developed.
The good news is there are proactive, preventative actions that can be taken to help reduce the risk of post-surgical adhesions.2,3 The importance of meticulous surgical technique alongside pharmacologic agents such as anticoagulants, fibrinolytics, anti-inflammatory and anti-fibrotic agents, is well recognized.2 But together these cannot eliminate the risk because the trauma that increases the risk of adhesions is a routine part of any surgery.2,3,6
Barrier methods in the form of films and solutions can provide additional support during the healing period.2 These act to physically separate tissues during this post-surgical healing phase, thus preventing them from forming adhesions.2,3 Evidence is growing that these methods can significantly reduce the risk of adhesions in abdominal and pelvic surgery, and thereby prevent the serious complications they can lead to.4,12
We must act proactively and preventatively to reduce the risk of post-surgical adhesions and improve outcomes for patients.
While the trauma routinely associated with surgical procedures means adhesions seem to be almost inevitable, their likelihood can be reduced by considering prevention methods before a procedure. If we are to avoid the significant consequences of adhesions for patients, as well as the heavy cost to healthcare providers, we must act proactively to reduce their risk and improve outcomes for patients.