Adhesions and their prevention

Adhesions are a common and unfortunate consequence of most abdominal surgical operations, which start to form within three hours of surgery. Some patients form extensive permanent adhesions that can cause abdominal or pelvic pain, infertility and bowel obstruction. Epidemiological studies have highlighted the extent of this problem and the cost to the Health Service, and although there are numerous approaches to prevent adhesion formation by careful laparoscopic or microsurgical techniques or the use of various adhesion barriers, no method so far has proved completely efficacious in randomised controlled trials. This article reviews the pathogenesis of adhesions, the epidemiological data and the various methods used to try to prevent their formation.