Surgical Adhesions: A Hidden Complication of Uterine Surgery
By Alicia Armeli

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You can’t see them but they could be the cause of infertility, bowel obstructions, and persistent pain. Despite the gravity of these conditions, it has been noted that specialists may be unaware of the severity of this hidden post-surgical problem.1 What’s also alarming is that due to this lack of awareness in the medical community, insurance companies may be reluctant to cover the costs.

Surgical adhesions—or scar tissue that forms between tissues and organs during the healing process—are a common complication of abdominal and pelvic surgery that affects a staggering 93 percent of patients.1

Normally, tissues and organs have smooth, slick surfaces that allow them to slide against each other with ease inside the body. When adhesions form, tissues and organs stick together, which can potentially lead to the aforementioned conditions. And if you’re a woman who has sought out surgery to treat fibroids—this could include you.

Surgically removing fibroids, as seen with myomectomy, may come with a catch—especially for women who are seeking procedures to preserve fertility. This is because the risk of adhesions may increase with each cut. And consequently, adhesions are reported to be the cause of 20-40 percent of secondary infertility cases.1

A recent European Journal of Obstetrics & Gynecology and Reproductive Biology study reported that, “the risk of adhesions increased with increasing number of fibroids removed.” 2

If adhesions form in or around the fallopian tubes, there’s an increased risk of ectopic pregnancy. If adhesions grow inside the uterus, they can block a fertilized egg from even reaching the uterine lining for implantation. Or if implantation does in fact occur, adhesions inside the uterus could disrupt pregnancy and result in repeat miscarriages.3

Overall, the reported risk of adhesions after myomectomy is considered low but still needs to be taken into consideration.4

Another major complication of adhesions is bowel obstructions—or a block in the intestines. Because adhesions cause tissues to stick together, intestines can become disorganized and pushed out of place. When this occurs, blood can no longer reach the intestines, which results in food and waste not being able to move through the intestines as normal. Bowel obstructions are painful and a very serious condition that needs immediate medical attention.5

An estimated 74 percent of bowel obstructions found in post-surgical patients are because of adhesions—especially in surgeries of the lower abdomen and pelvis, as seen in gynecological surgeries like hysterectomy.1,5

But the statistics can vary. A study published in the Journal of Minimally Invasive Gynecology looked at the incidences of small bowel obstructions in 3,229 women who had a hysterectomy for benign reasons over the course of nine years. Results of the study showed that only 17 women had small bowl obstructions.6

“The incidence of small bowel obstruction after hysterectomy performed because of benign indications is low,” the authors concluded. What’s more, in this study, the type of hysterectomy performed (abdominal, vaginal, or laparoscopic) didn’t seem to make a difference in terms of risk. Other studies support and dispute these findings. 7

Varying statistics like these suggest that the exact reason for adhesion growth isn’t entirely clear.2,4,6,7  Adhesions have been seen to form even after non-surgical procedures like uterine fibroid embolization (UFE). Although a small percentage, one study showed 14 percent of women to develop adhesions after UFE.2

This indicates that adhesion growth may depend on various factors such as age, prior history of abdominal surgery, a predisposition for the condition, and undergoing procedures that impede blood flow to the tissue.2,7

For this reason, it’s important that women speak openly to their gynecologists before and after surgery. Medical prevention guidelines advocate for creating a care plan that reduces the risk of adhesions—especially for high-risk surgeries.1

Preoperatively, this can include discussing your own personal risk factors, all surgical options available to you, and the use of anti-adhesion products during surgery.1 After your surgery, an early detection plan to monitor adhesion growth is advised.4

Patient care doesn’t start and end in the operating room but is ongoing and crucial in order to reduce the risk of painful post-surgical complications like adhesions.

 

REFERENCES

  1. De Wilde, R. L., Brolmann, H., Koninckx, P. R., Lundorff, P., Lower, A. M., Wattiez, A., Mara, M., Wallwiener, M., & the Anti-Adhesions in Gynecology Expert Panel (ANGEL). (2012). Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecological Surgery, 9(4): 365-368. doi: 10.1007/s10397-012-0764-2
  2. Conforti, A., Krishnamurthy, G. B., Dragamestianos, C., Kouvelas, S., Micallef, F. A., Tsimpanakos, I., & Magos, A. (2014). Intrauterine adhesions after open myomectomy: an audit. European Journal of Obstetrics & Gynecology and Reproductive Biology, 179: 42-45. doi: 10.1016/j.ejogrb.2014.04.034
  3. National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Abdominal Adhesions. Retrieved October 5, 2015, from http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/abdominal-adhesions/Pages/facts.aspx
  4. Gambadauro, P., Gudmundsson, J., & Torrejon, R. (2012). Intrauterine adhesions following conservative treatment of uterine fibroids. Obstetrics and Gynecology International, 853269. doi: 10.1155/2012/853269
  5. University of California San Francisco Department of Surgery. (2015). Abdominal Adhesions and Bowel Obstruction. Retrieved October 5, 2015, from http://www.surgery.ucsf.edu/conditions–procedures/bowel-obstruction.aspx
  6. Muffly, T. M., Ridgeway, B., Abbott, S., Chmielewski, L., & Falcone, T. (2012). Small bowel obstruction after hysterectomy to treat benign disease. Journal of Minimally Invasive Gynecology, 19(5): 615-619. doi: 10.1016/j.jmig.2012.05.011.
  7. Angenete, E., Jacobsson, A., Gellerstedt, M., Haglind, E. (2012). Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study. Archives of Surgery, 147(4): 359-365.