How do adhesions occur?

3. April 2012

How do adhesions occur?

Rarely adhesions are present from birth. 

Adhesions commonly form in the abdominal-pelvic cavity as a result of inflammation, injury or following surgery – as part of the body’s completely natural and normal healing process. 

Usually they occur as part of the healing that takes place after surgery, particularly abdominal surgery. 

Adhesions can also form after inflammation in the abdomen or pelvis. 

Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, trauma, or radiation. 

Repair cells within the body cannot tell the difference between one organ and another. If an organ undergoes repair and comes into contact with another part of itself, or another organ, scar tissue may form to connect the 2 surfaces. 

BIOCHEMICAL EVENTS LEADING TO FORMATION OF ADHESIONS

 


  • During the body’s reaction that leads to an adhesion, chemicals called inflammatory mediators and histamines are released from the blood (more specifically the blood’s mast cells and leukocytes).
  • Capillaries dilate. This allows leukocytes, red blood cells and platelets to concentrate at the injury site in a bundle called a fibrinous exudate.
  • A variety of other factors are at play in the system such as as prostaglandins, bradykinin, chemotactic agents, lymphokines, seretonin and transforming growth factor.
  • At this point in time fibrinolysis may clear the fibrinousexudate.
  • In order for this to occur, plasminogen must be converted to plasmin by tissue plasminogen activator (t-PA). There is constant interplay between the t-PA and plasminogen-activator inhibitors.
  • Unfortunately surgical trauma normally decreases t-PA activity while simultaneously increasing plasminogen activator inhibitors.
  • If this occurs, the fibrinous exudate is transformed into an organized adhesion where fibers of collagen are deposited.
  • Blood vessels begin to form, which leads to an adhesion.
  • 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
    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
    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:

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

    Ischemia:
    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. 

    Inflammation: 
    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

     

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