Intra-abdominal adhesions are fibrous bands that form between tissues and organs following surgery, infection, inflammation, or trauma. They are a significant cause of postoperative complications, including chronic abdominal pain, infertility, and intestinal obstruction. Adhesions can develop after almost any abdominal or pelvic surgery, with incidence rates ranging from 60% to 90% in patients undergoing repeated operations.

Adhesiolysis refers to the surgical process of removing these adhesions to restore normal anatomy and function. At the same time, preventing the formation of new adhesions is equally critical to minimize morbidity and improve long-term outcomes. Dr. R. K. Mishra, a world-renowned expert in minimally invasive surgery, has extensively lectured on adhesiolysis techniques and strategies for adhesion prevention, emphasizing both safety and efficacy.

Causes of Adhesion Formation

Adhesions typically develop due to a disturbance in the normal healing process of the peritoneum. Common causes include:

Previous abdominal or pelvic surgeries – especially laparotomy

Peritonitis – secondary to infection or perforated viscera

Endometriosis – causing chronic pelvic inflammation

Hemorrhage – blood in the peritoneal cavity can trigger fibrosis

Foreign materials – such as sutures or talc from gloves

Trauma – accidental injury during surgery

The formation of adhesions is the body’s attempt to repair tissue injury, but excessive scar tissue can tether organs together, leading to functional problems.

Indications for Adhesiolysis

Surgical removal of adhesions is indicated in cases of:

Small bowel obstruction – adhesions are the leading cause of postoperative obstruction.

Chronic pelvic or abdominal pain – when adhesions restrict organ mobility.

Infertility – particularly in women with tubal adhesions or endometriosis.

Preparation for subsequent surgery – to prevent inadvertent injury during reoperation.

The decision to perform adhesiolysis must be carefully weighed, as the procedure itself can trigger new adhesion formation if not done properly.

Surgical Techniques for Adhesiolysis
Open vs. Laparoscopic Approach

Open Adhesiolysis: Traditional laparotomy allows direct access to adhesions but is associated with a higher risk of new adhesion formation.

Laparoscopic Adhesiolysis: Minimally invasive surgery is preferred for its precision, reduced tissue trauma, and lower risk of adhesion recurrence.

Key Principles

Gentle Tissue Handling: Avoid aggressive traction or rough dissection.

Sharp vs. Blunt Dissection: Sharp dissection with scissors is preferred for dense adhesions, while blunt dissection is suitable for loose adhesions.

Adequate Visualization: Proper exposure and magnification help prevent injury to underlying organs.

Controlled Hemostasis: Excessive bleeding triggers fibroblast activity, promoting adhesion formation.

Energy Devices

Monopolar or bipolar cautery, ultrasonic shears, or advanced vessel-sealing devices can be used judiciously to divide adhesions while minimizing thermal damage to surrounding tissues.

Adhesion Prevention Strategies

Preventing adhesion formation is a crucial aspect of modern surgery. Dr. R. K. Mishra emphasizes a multimodal approach to adhesion prevention, including surgical technique, pharmacologic agents, and barrier methods.

Meticulous Surgical Technique

Minimize tissue trauma and desiccation

Use fine instruments and gentle retraction

Maintain adequate hemostasis

Reduce the use of foreign materials such as gauze or rough sutures

Barrier Methods

Physical barriers placed between tissues can prevent them from adhering during healing. Options include:

Hyaluronic acid-carboxymethylcellulose membranes

Oxidized regenerated cellulose

Seprafilm or similar bioresorbable films

These barriers are placed over exposed surfaces at the end of surgery to reduce fibrin bridge formation.

Pharmacologic Agents

While no drug completely prevents adhesions, some interventions have shown promise:

Anti-inflammatory agents to reduce postoperative inflammation

Fibrinolytic agents to decrease fibrin deposition

Minimally Invasive Approaches

Laparoscopic surgery inherently reduces adhesion risk by limiting tissue handling, blood exposure, and peritoneal desiccation.

Postoperative Considerations

Early mobilization and gentle activity may reduce adhesion-related discomfort.

Adequate hydration and nutrition support tissue healing.

For women with infertility, timely follow-up and reproductive evaluation are recommended.

Conclusion

Adhesiolysis and adhesion prevention are critical components of safe and effective abdominal and pelvic surgery. While adhesions are a natural part of the healing process, they can cause significant morbidity if left unmanaged. Laparoscopic adhesiolysis, when performed carefully, restores organ mobility and relieves symptoms with minimal risk of recurrence.

Prevention strategies—including meticulous surgical technique, use of physical barriers, pharmacologic interventions, and minimally invasive approaches—are essential to reduce the incidence of postoperative adhesions.

Under the guidance of experts like Dr. R. K. Mishra, surgeons can achieve optimal outcomes by combining precise adhesiolysis with effective adhesion prevention, improving patient quality of life and reducing long-term complications.