Abdominal Surgery and Adhesions

Abdominal surgery is broadly defined as any operation in the abdominal region of the body, roughly between the bottom of the rib cage and the top of the pelvis. The abdominal region contains the stomach, liver, pancreas, kidneys, colon, spleen and intestines. All these organs are subject to injury and disease, which often require surgery to repair or eradicate.

Types of Abdominal Surgeries

Open surgery is the traditional abdominal surgery technique. In this type of surgery, the surgeon makes a large incision on the surface of the abdomen to be able to reach the diseased or injured organ deep inside the abdominal cavity.

Laparoscopic surgery is another technique. In this type of surgery, the surgeon makes several small incisions on the surface—usually in the groin area, not in the abdomen itself—and inserts tiny lights and cutting instruments through catheters. The surgeon completes the procedure guided by computerized imaging.

Abdominal Surgery and Internal Scarring

Because the surgeon must cut tissue in the abdominal organs, scars—also called scar tissue or adhesions—form at incision sites. For most surgical patients, abdominal adhesions cause no problem. Internal scarring is a natural process. Adhesions form the body’s first line of defense against injury or inflammation and are a common consequence of abdominal surgery. They are necessary for healing. Studies have show that adhesions appear in about 93 percent of patients who undergo major abdominal surgery.

Abdominal adhesions can also come from infections or inflammation in the abdominal regions, particularly appendicitis. But abdominal surgery is the most frequent source of internal scarring.

Abdominal adhesions are tough rope-like bands of tissue that can cover an organ or form between two organs, joining them together. In either case, the scar tissue can prevent the organ or organs from functioning normally or from shifting freely, as they naturally do when the body moves. When this happens, serious problems can develop.

Problems from Adhesions

Not all patients experience problems from abdominal adhesions. Of those who do, the most common complaint is chronic, sometimes intense, pain in the abdominal or pelvic region. Another possible problem affects women. If the scar tissue interferes with the organs of the female reproductive system, temporary or permanent infertility might ensue.

One familiar problem brought about by abdominal adhesions is partial or complete bowel obstruction. A study published several years ago reported that up to 75 percent of small-bowel obstructions were caused by adhesions. Bowel obstruction is a blockage somewhere in the large or small intestine that prevents it from functioning normally. The intestines play a major role in digestion.

A bowel obstruction can be a serious, life-threatening disorder. Studies have found that up to 5 percent of patients with bowel obstruction die from the condition. The bowl obstruction might prevent food from moving through the digestive tract and cutting off the body’s supply of nourishment. Or the bowel obstruction might prevent waste material from exiting the body, thus poisoning the body. Or the bowel obstruction might restrict the normal blood supply to the affected section of the bowel, causing the tissue in that part of the bowel to die. This is a medical emergency requiring immediate surgery.

Treatment for Adhesions

Abdominal adhesions can’t be prevented, but they can be treated. Some physical therapy techniques work to break down the scar tissue. Usually a surgical procedure called an adhesiolysis (ad-heez-ee-OH-lis-is) is performed. However, this means additional surgery, which usually leads to more adhesions and the problem of adhesions recurring.