Adhesiolysis is a surgical procedure to divide or remove adhesions, which are bands of scar-like tissue that can form between internal organs and tissues. These adhesions can develop as a result of surgery, infection, trauma, or inflammation, causing organs to adhere to one another abnormally. While many adhesions are asymptomatic and require no intervention, some can lead to significant complications, including chronic pain, bowel obstruction, and infertility.
In This Article:
- Key Takeaways
- What are Adhesions?
- When is Adhesiolysis Necessary?
- The Adhesiolysis Procedure
- Recovery After Adhesiolysis
- Factors Contributing to Adhesion Recurrence
- Alternatives to Adhesiolysis
- FAQs
- How long does adhesiolysis surgery take?
- Will I have scars after adhesiolysis?
- What is the success rate of adhesiolysis?
- Can adhesions be prevented?
- When can I return to work after adhesiolysis?
- What are the risks of adhesiolysis surgery?
- Can adhesions come back after surgery?
- What is the difference between laparoscopic and open adhesiolysis?
- What kind of pain medication will I need after surgery?
- How soon can I exercise after adhesiolysis?
- Conclusion
- Novus Spine and Pain Center
- Additional Resources
Key Takeaways
- Adhesions are bands of scar-like tissue that can form between internal organs and tissues, often as a result of surgery, infection, or inflammation.
- Many adhesions are asymptomatic and do not require treatment.
- Adhesiolysis is a surgical procedure to remove adhesions that are causing significant symptoms, such as chronic pain, bowel obstruction, or infertility.
- The decision to perform adhesiolysis is made on an individual basis. It is often considered only when symptoms are severe or significantly impact the quality of life due to the risks associated with surgery.
- Adhesiolysis can be performed laparoscopically (minimally invasive) or through an open surgical approach, depending on the specific circumstances.
- Recovery from adhesiolysis varies depending on the surgical approach and the extent of the adhesions.
- Potential complications of adhesiolysis include adhesion recurrence, infection, bleeding, and injury to surrounding organs.
- Non-surgical management options, such as pain medication and dietary changes, may be appropriate for some patients with mild symptoms.
What are Adhesions?
Adhesions are bands of scar-like tissue that develop between two surfaces in the body that are usually not connected. These surfaces stick together (adhere), which can lead to complications. Understanding how adhesions form is necessary for recognizing the need for procedures like adhesiolysis.
Defining Adhesions
Adhesions are composed of fibrous tissue, similar to the scar tissue that forms after an injury to the skin. They represent an abnormal part of the body’s natural healing process. Although they occur throughout the body, adhesions most frequently develop within the abdominal cavity, the pelvic region, and around the heart. They can also form in joints, around the spine, and even within the eyes.
While seemingly simple in structure, the adhesion’s origin can be complex. The causes of adhesions include:
- Surgery: Surgical procedures involving the abdomen and pelvis are the most common cause of adhesions. The cutting, handling, and manipulation of tissues during surgery trigger an inflammatory response, which can lead to adhesion formation. Even minimally invasive laparoscopic surgery carries a risk, albeit lower than open surgery.
- Infection: Infections within the body, such as pelvic inflammatory disease (PID), appendicitis, or diverticulitis, can cause inflammation and subsequent adhesion development. The body’s response to fight the infection often results in scar tissue formation. This scar tissue can bind organs and tissues together.
- Inflammation: Inflammatory conditions not directly related to infection, such as endometriosis, Crohn’s disease, and ulcerative colitis, can also promote adhesion formation. These conditions cause chronic inflammation in the affected tissues. This persistent inflammation can lead to the development of adhesions.
- Trauma: Physical trauma to the abdomen or pelvis, such as from a car accident or a fall, can cause internal injuries and bleeding. This trauma can lead to adhesion development. The body’s attempt to repair the damage can inadvertently create these abnormal tissue connections.
- Radiation Therapy: Radiation used to treat cancer will often cause inflammation. This can lead to the formation of adhesions. The adhesions most commonly affect the area being treated.
- Foreign Materials: In rare cases, foreign materials left inside the body after surgery (e.g., gauze, sutures) can trigger an inflammatory response and adhesion formation. Although rare, it still is a possible cause. Modern surgical techniques and materials aim to minimize this risk.
It’s important to understand that while these factors increase the risk of adhesion formation, they don’t guarantee it. Many individuals undergo surgery or experience inflammation without developing clinically significant adhesions. Genetic and biological factors are suspected to contribute to individual variations in adhesion formation, but research is ongoing.
Symptoms of Adhesions
The development of adhesions varies significantly depending on their location and extent. Many individuals with adhesions remain asymptomatic, experiencing no noticeable effects. However, in other cases, adhesions can cause a range of problems.
Common symptoms include chronic pain, often localized to the area of the adhesions. In the abdomen, adhesions can lead to bowel obstruction, a serious condition characterized by the blockage of the intestines. Adhesions in the female reproductive tract can contribute to infertility by obstructing the fallopian tubes. Less frequent but dangerous complications may include bowel strangulation.
When is Adhesiolysis Necessary?
Adhesiolysis, the surgical procedure to remove adhesions, is not always required for individuals with adhesions. Many adhesions have no symptoms and do not necessitate intervention. The decision to proceed with adhesiolysis is based on carefully evaluating the patient’s symptoms and overall health. In many cases, conservative measures are recommended before resorting to surgery to relieve the pain.
Indications for Adhesiolysis
Surgical intervention becomes a consideration when adhesions cause significant health problems. One of the primary indications is chronic pain that substantially impacts the quality of life for the patient.
Another critical indication is bowel obstruction, whether partial or complete, caused by abdominal adhesions. This condition can be life-threatening and often requires prompt surgical intervention. Furthermore, adhesiolysis may be indicated in cases of female infertility where adhesions are determined to be obstructing the fallopian tubes or affecting ovarian function.
In general, impaired organ function may be a reason for surgery.
Diagnosing Adhesions
Diagnosing adhesions can be challenging because they are often thin, translucent, and blend in with surrounding tissues, making them difficult to visualize using standard imaging techniques like X-rays, CT scans, and ultrasounds. While these techniques are not ideal for directly diagnosing adhesions, they can sometimes reveal indirect signs of adhesions, such as evidence of bowel obstruction.
Specialized imaging techniques, such as dynamic or cine MRI (which shows movement) and ultrasound elastography (which assesses tissue stiffness), can sometimes provide additional information suggesting adhesions, particularly when standard imaging is inconclusive. However, these specialized techniques are not widely available.
Laparoscopy, a minimally invasive surgical procedure, can be a reliable method for confirming the presence and extent of adhesions. However, it is not a first-line diagnostic test for adhesions. Laparoscopy is a surgical procedure and is typically only used when:
- There is a strong clinical suspicion of adhesions causing significant symptoms.
- Less invasive diagnostic options have been inconclusive, or the findings suggest a surgical problem (e.g., bowel obstruction).
- There is a reasonable likelihood that adhesiolysis would be performed if adhesions are found during the laparoscopy.
A comprehensive assessment, encompassing the patient’s medical history and a thorough physical examination, is vital. It’s critical to differentiate adhesion-related symptoms from other potential causes. This careful evaluation, in conjunction with imaging studies, helps the surgeon determine the appropriateness of a diagnostic laparoscopy with possible adhesiolysis.
The Adhesiolysis Procedure
Adhesiolysis is a surgical procedure to release or remove adhesions, restoring normal anatomy and function. The specific approach depends on the adhesions’ location and extent and the patient’s overall health. The procedure is typically performed under general anesthesia.
Types of Adhesiolysis
There are two primary surgical approaches for adhesiolysis:
- Laparoscopic adhesiolysis is a minimally invasive technique that involves making several small incisions in the abdomen. A laparoscope (a thin, telescope-like instrument with a camera) and specialized surgical tools are inserted through these incisions to remove the adhesions.
- Open adhesiolysis, in contrast, requires a larger incision to access the affected area directly. This approach may be used in cases of extensive adhesions or when laparoscopic surgery is not feasible. The choice between laparoscopic and open adhesiolysis is made on an individual basis.
What to Expect During Surgery
During the procedure, the patient will be under general anesthesia, ensuring they are completely asleep and pain-free. The surgeon will carefully identify the adhesions and use sharp dissection, scissors, or a laser to meticulously cut and release them. The goal is to restore normal anatomical relationships and relieve any obstruction or restriction caused by the adhesions.
Once the adhesions have been removed, the incisions are closed with sutures, staples, or surgical glue. The specific closure method depends on the type of surgery and the surgeon’s preference. The duration of surgery can vary considerably depending on the case’s complexity.
Recovery After Adhesiolysis
The recovery process following adhesiolysis varies depending on the surgical approach (laparoscopic or open) and the extent of the adhesions addressed. Close adherence to the medical team’s post-operative instructions is essential for optimal healing. The recovery can be considered in stages, from immediate post-operative care to long-term considerations.
Immediate Post-Operative Care
Immediately after surgery, patients are monitored in a recovery room until the effects of anesthesia have worn off. Vital signs, such as heart rate and blood pressure, are closely observed. Pain management is initiated, often with intravenous medications, and transitioned to oral medications as tolerated.
The length of hospital stay varies; laparoscopic procedures may allow for same-day discharge or a short stay. Open surgery typically requires a longer hospitalization. Your doctor will determine when discharge is appropriate.
Short-Term Recovery (First Few Weeks)
During the initial weeks following surgery, some degree of pain and discomfort is expected at the incision sites. This is typically managed with prescribed pain medication. Activity restrictions are usually in place, including limitations on lifting heavy objects and strenuous exercise.
Patients are provided with specific instructions regarding wound care to prevent infection. Dietary recommendations, particularly after abdominal surgery, may also be given to ease bowel function. Additionally, follow-up appointments with the surgeon are scheduled to monitor healing and address concerns.
Long-Term Recovery and Potential Complications
The long-term outlook after adhesiolysis is generally positive, with many patients experiencing significant relief from pain and improved organ function. However, it is important to acknowledge potential complications and the possibility of adhesion recurrence, even after successful surgery. One study found the long-term effects of laparoscopic adhesiolysis for chronic abdominal pain may be limited.
Other potential complications include infection, bleeding, and injury to surrounding organs during the procedure. Bowel obstruction, while often the reason for surgery, can also occur as a complication, such as persistent or worsening pain, fever, redness, or drainage from the incision sites.
Factors Contributing to Adhesion Recurrence
Several factors can influence the likelihood of adhesions reforming after they have been surgically removed. These factors are complex and often interconnected, making predicting recurrence with absolute certainty challenging.
- Extent of Initial Adhesions: Patients with extensive and dense adhesions at the initial surgery are at higher risk of recurrence. The more widespread the initial problem, the greater the surface area where new adhesions can form. This is a significant predictor of future issues.
- Underlying Cause of Adhesions: The original cause of the adhesions plays a role. Adhesions resulting from ongoing inflammatory conditions (like endometriosis or Crohn’s disease) are more likely to recur than adhesions from a single, resolved event (like a past appendectomy).
- Surgical Technique: While meticulous surgical technique aims to minimize tissue trauma, surgery itself can stimulate the healing response and, potentially, new adhesion formation. Laparoscopic surgery, generally associated with less tissue trauma than open surgery, may have a lower but not zero risk of recurrence. Furthermore, the skill and experience of the surgeon are also relevant factors.
- Genetic Predisposition: Individual variations in the body’s healing response, likely influenced by genetics, can affect the propensity for adhesion formation and recurrence. Some individuals are more prone to forming scar tissue, both externally (e.g., keloids) and internally (adhesions). However, this predisposition is not yet fully understood.
- Post-operative Complications: Complications after adhesiolysis, such as infection or bleeding, can increase the risk of new adhesions forming. Any event that triggers inflammation in the post-operative period can contribute to recurrence.
- Use of Adhesion Barriers: While surgeons may use adhesion barriers (specialized films or solutions) during surgery to prevent recurrence, these are not foolproof. Their effectiveness varies depending on the specific product, the location of the adhesions, and other patient-specific factors.
- Time: The risk of adhesion recurrence depends on factors such as the extent of initial adhesions, underlying conditions, and future surgeries or inflammation.
However, even with the best surgical techniques and preventative measures, adhesion recurrence remains possible. Patients should have a frank discussion with their surgeon about their risk factors and the potential for recurrence before undergoing adhesiolysis.
Alternatives to Adhesiolysis
While adhesiolysis is an effective treatment for adhesions, non-surgical options may be considered, particularly when symptoms are mild or when surgery is not feasible. The suitability of these alternatives depends on the patient’s specific circumstances and the nature of their adhesions.
Various pain management strategies may be employed for patients experiencing pain related to adhesions. These can include over-the-counter or prescription pain relievers, nerve blocks, or other interventional pain procedures.
Physical therapy may also help. Techniques such as visceral manipulation or myofascial release may also help improve mobility and reduce discomfort in some cases with pain related to adhesions.
Additionally, non-surgical management may include pain medication, dietary modifications, other therapies such as anti-inflammatory medications (though not very effective for established adhesions), or specialized physical therapy techniques.
However, non-surgical approaches primarily address the symptoms of adhesions and do not eliminate the adhesions themselves.
FAQs
How long does adhesiolysis surgery take?
The duration of adhesiolysis surgery varies significantly depending on several factors. These include the extent and location of the adhesions, the surgical approach used (laparoscopic or open), and any unexpected findings during the procedure. A simple laparoscopic adhesiolysis for limited adhesions might take less than an hour. However, a laparoscopic procedure could take several hours if the adhesions are extensive.
Likewise, a complex open adhesiolysis involving extensive adhesions in multiple areas of the abdomen could take several hours.
Will I have scars after adhesiolysis?
The presence and extent of scarring after adhesiolysis depend on the surgical approach used. Laparoscopic adhesiolysis, a minimally invasive technique, typically results in several small scars, often less than an inch long. These scars are usually located where the surgical instruments and camera were inserted.
Open adhesiolysis, on the other hand, involves a larger incision, which will result in a more prominent scar. The size and location of this scar will depend on the specific area being addressed. While surgeons strive to minimize scarring, some scarring is unavoidable with any surgical procedure. However, proper wound care can help minimize the appearance of scar tissue.
What is the success rate of adhesiolysis?
The success rate of adhesiolysis is variable and depends on several factors, including the underlying cause of the adhesions, their location and extent, and the patient’s overall health.
Defining “success” will be different for each patient. While success might be complete pain relief for some, for others, it might be a reduction in pain or improved bowel function, even if the adhesions are not completely gone. For example, studies show that laparoscopic adhesiolysis results in significant pain reduction in over 60% of patients one year after surgery.
Before proceeding with surgery, a thorough discussion with your surgeon about the expected outcomes and potential for recurrence is essential. The recurrence risk varies significantly depending on factors such as the extent of adhesions, surgical technique, and use of adhesion prevention methods.
Can adhesions be prevented?
Complete prevention of adhesions is not always possible, particularly after abdominal or pelvic surgery. However, several strategies can help minimize their formation. For example, surgeons employ meticulous surgical techniques, including gentle tissue handling and careful bleeding control, to reduce the risk.
Furthermore, surgical barriers or solutions can sometimes be used during surgery to help separate tissues and prevent them from sticking together during the healing process. These are not universally applicable, and their use is determined by the surgeon on a case-by-case basis.
When can I return to work after adhesiolysis?
The timeframe for returning to work after adhesiolysis depends on several factors, primarily the type of surgery (laparoscopic or open), the physical demands of your job, and your healing process. For less physically demanding jobs and after laparoscopic procedures, some individuals may be able to return to work within one to two weeks.
However, for more physically demanding jobs or after open surgery, the recovery period may be longer, potentially requiring several weeks or even months before returning to full duties. Your surgeon will provide personalized guidance based on your specific circumstances and advise you when it is safe to resume work and other activities.
What are the risks of adhesiolysis surgery?
Adhesiolysis, like any surgical procedure, carries certain risks. These risks can range from relatively minor complications to more serious ones. Common, less severe risks include wound infection, bleeding, and pain at the incision sites. These are usually manageable with appropriate medical care.
More serious, although less frequent, complications can include injury to surrounding organs (such as the bowel, bladder, or blood vessels), bowel obstruction, and the recurrence of adhesions.
Anesthesia also carries its own set of risks, which will be discussed with you by the anesthesiologist before surgery.
Can adhesions come back after surgery?
Yes, adhesions can recur after adhesiolysis. This is one of the inherent challenges of adhesion surgery.
The body’s natural healing response, which can lead to the initial formation of adhesions, may also cause them to reform after surgically removing them. Furthermore, the likelihood of recurrence varies depending on several factors, including the adhesions’ original cause, the surgery’s extent, and individual patient factors.
What is the difference between laparoscopic and open adhesiolysis?
Laparoscopic adhesiolysis is a minimally invasive surgical technique. It involves making several small incisions (typically less than an inch) in the abdomen, through which a laparoscope (a thin, lighted tube with a camera) and specialized surgical instruments are inserted to view and remove the adhesions. This approach generally results in less pain, smaller scars, and a faster recovery.
Open adhesiolysis, in contrast, requires a larger incision to access the abdominal cavity and the adhesions directly. This allows the surgeon a wider field of view and more direct access to the adhesions, which may be necessary in cases of extensive or complex adhesions.
What kind of pain medication will I need after surgery?
The type and amount of pain medication required after adhesiolysis varies depending on the extent of the surgery, the individual’s pain tolerance, and the surgical approach (laparoscopic or open).
It is common practice to use a combination of different types of pain relief techniques and medications, such as NSAIDs, acetaminophen, and nerve blocks, to minimize opioid use and improve pain control. Your surgeon will provide a specific pain management plan tailored to your needs, so communicate any concerns or inadequate pain control to your medical team.
How soon can I exercise after adhesiolysis?
The timing for resuming exercise after adhesiolysis depends on the extent of the surgery, the type of exercise, and your healing progress. Gentle walking is usually encouraged soon after surgery, as it promotes circulation and helps prevent complications. However, more strenuous activities, such as heavy lifting, running, or high-impact aerobics, will need to be avoided for several weeks or even months, depending on the extent of the surgery and your surgeon’s recommendations.
Conclusion
Adhesiolysis is a surgical procedure that can provide significant relief for individuals experiencing complications from adhesions. While adhesions are a common occurrence, particularly after abdominal or pelvic surgery, intervention is only needed when they cause substantial symptoms or impair organ function. The decision to proceed with adhesiolysis is made on a case-by-case basis, considering the potential benefits and risks.
Individuals experiencing symptoms potentially related to adhesions should consult with a physician specializing in pain management. A thorough evaluation will help determine the underlying cause of the symptoms and guide the appropriate management strategy, whether it be surgical intervention, alternative therapies, or watchful waiting.
Novus Spine and Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating the pain resulting from scar tissue. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle while minimizing the need for opiates.
For your convenience, you may schedule an appointment online, request a callback, or call our office at 863-583-4445.
Additional Resources
Intestinal obstruction (Mayo Clinic)
Abdominal Adhesions (National Institute of Diabetes and Digestive and Kidney Diseases)
Adhesions (MedlinePlus (National Library of Medicine)
Updated: March 4, 2025
