The Risk of Adhesions after Gynecologic Surgery

Summarized by September 12, 2006
Dr Gregory Fossum is a very experienced OBGYN, who has written an interesting article about the risk of adhesions in women undergoing surgery for a variety of reasons, including the ever-growing number of Cesarean sections. Robert Griffith, Editor.
Adhesions are a little recognized yet widespread healthcare problem affecting as many as 94% of patients who undergo abdominal or gynecologic surgery, such as a Cesarean section, hysterectomy, or myomectomy (a surgery to remove fibroids which are non-cancerous growths in the uterus).1,2 Painful and debilitating complications can arise from adhesion formation, so that prevention of adhesions should be considered during surgery.
Adhesions are bands of tissue that form between organs in response to injury caused during surgery. These bands can be dense, causing internal organs and tissues to bind together, thereby limiting the natural, free motion of organs. The resulting twisting and pulling of these structures accounts for up to 74% of small bowel obstruction cases, 20% to 50% of chronic pelvic pain cases and up to 20% of infertility cases.3 Adhesions can also increase the risk, complexity, time and complications during Cesarean sections. Studies have recently emerged revealing significant rates of adhesion formation after C-section - in one report, adhesions formed in 73% of primary C-section patients.4
Women are most likely unaware of the risk of adhesion formation after a Cesarean section. With 70% of C-sections being unplanned, even if you are not planning for a C-section, it is important to ask your OBGYN about adhesions and the potential risks associated with them to prevent complications from arising in the future.
Once formed, adhesions can only be removed through surgery. However, since adhesions are caused by surgery, it is likely that they will re-form. With more than one million Cesarean sections taking place in the United States each year, there is a growing need to institute measures to prevent adhesion formation.
Although good surgical technique is helpful for reducing adhesions, it is not the only means of prevention. Adhesion barriers act as a physical barrier to separate tissues involved in surgery from other tissues and organs. Use of barriers can help to reduce the incidence, extent and severity of adhesions by separating injured tissues during the healing process.
An example of an adhesion barrier is Seprafilm®, manufactured by Genzyme Corporation. Seprafilm, a physical barrier composed of chemically modified sugars, some of which occur naturally, is placed on and around the surgical site before closure. After application, it becomes a gel that remains in place between tissues and organs during the body's normal healing process. It is slowly absorbed by the body within one week and its components are passed from the body in less than 28 days.
Another adhesion barrier approved by the Food and Drug Administration (FDA) for this use is Interceed Barrier®, made by Johnson & Johnson. Interceed is derived from oxidized regenerated cellulose. Its clinical properties are similar to those of Seprafilm. Gore-Tex® has also been used in the past for this purpose, but it doesn't dissolve, and must therefore be removed later. Other products are in clinical development.
Source
Gregory T. Fossum, MD, Associate Professor of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, and Director of Reproductive Endocrinology at the Center for Reproductive Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
Footnotes 1. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. JM. Becker, MT. Dayton, VW. Fazio, et al., J Am Coll Surg, 1996, vol. 183, pp. 297--3062. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. BJ. Monk, ML. Berman, FJ. Montz, Am J Obstet Gynec, 1994, vol. 170(5), pp. 1396--14033. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. BJ. Monk, ML. Berman, FJ. Montz, Am J Obstet Gynec, 1994, vol. 170(5), pp. 1396--14034. Peritoneal closure at primary Cesarean delivery and adhesions. DJ. Lyell, AB. Caughey, E. Hu, K. Daniels, Obstet Gynecol, 2005, vol. 106, pp. 275--80
Related Links
The UK Adhesion Society
Women's Surgical Group: Adhesions
Baylor College of medicine: Adhesions
International Adhesion Society

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