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Adhesiolysis is the surgical division of intra-abdominal or pelvic adhesions, performed to relieve complications such as adhesive small bowel obstruction, chronic abdominopelvic pain, infertility related to pelvic adhesive disease, or to facilitate safe reoperative surgery. This procedure can be undertaken through open, laparoscopic, or robotic techniques, with minimally invasive approaches generally associated with lower morbidity, shorter hospital stays, less postoperative pain, and a reduced risk of future adhesion formation. Nevertheless, the procedure carries notable risks, including inadvertent bowel injury, which occurs in up to 10% of cases, as well as bleeding, infection, and potential recurrence of adhesions. Careful patient selection, meticulous surgical technique, and adjunctive barrier methods or pharmacologic agents when appropriate are critical to improving outcomes and minimizing complications. By participating in this course, clinicians strengthen their understanding of the indications, contraindications, and technical considerations of adhesiolysis and learn evidence-based strategies to reduce postoperative morbidity. They gain practical insights into patient selection, preoperative planning, and intraoperative techniques—including safe entry methods, energy device use, and adhesion-prevention barriers—while enhancing interprofessional communication and postoperative care coordination skills. This comprehensive knowledge equips surgeons, advanced practitioners, and allied health professionals to deliver safer, more effective, patient-centered care to individuals requiring adhesiolysis. Objectives: Identify the most likely pathophysiological factors for adhesion formation after abdominal surgery. Determine the complications related to postoperative adhesions and the indications and contraindications for adhesiolysis. Apply knowledge of the different methods of adhesion prevention and adhesiolysis. Collaborate with all members of the interprofessional team including specialists such as anesthesiologists, gastroenterologists, surgeons, and pain management specialists to provide efficient, comprehensive, and coordinated care to patients with abdominal adhesion-related pain and bowel obstruction. Access free multiple choice questions on this topic.

Adhesions are abnormal fibrous connections that develop between normally separated tissue surfaces within body cavities. Their morphology ranges from delicate, almost translucent connective tissue films to dense, vascularized fibrous bands capable of distorting normal anatomy and function.[1] Although adhesions can form in diverse locations, including the peritoneum, tendons, heart, epidural space, and uterus, to name a few, they most frequently occur within the peritoneal cavity. Postoperative peritoneal adhesions develop in approximately 90% of patients after open abdominal surgery and in about 70% following laparoscopic procedures, making them a significant and common surgical sequela.[2][3] Multiple factors can trigger adhesion formation, including tissue trauma, ischemia, mechanical or thermal irritation, and foreign materials such as fibers, powders, or irritating fluids, all contributing to oxidative stress.[4] The precise pathophysiology, however, remains incompletely defined, with no single unifying mechanism. Current evidence suggests that peritoneal or serosal injury, whether from surgery or severe intra-abdominal infection, disrupts the mesothelial surface and activates coagulation and inflammatory signaling pathways. Yet these mechanisms do not fully account for all presentations, including congenital adhesions.[1][2][5] The most clinically significant consequences of adhesion formation are chronic abdominal pain and adhesive small bowel obstruction, which are closely linked conditions. Up to 25% of patients with chronic adhesion-related pain experience episodes of adhesive obstruction.[3] Pain is thought to result from restricted visceral mobility, which stimulates visceral stretch receptors and nociceptive nerve fibers within the adhesions. When adhesions tether abdominal organs to each other or the abdominal wall, they may obstruct the bowel, often necessitating hospitalization and, in some cases, surgical adhesiolysis, the surgical dissection of the fibrous bands, to relieve obstruction.[6]

The most clinically significant consequences of adhesion formation are chronic abdominal pain and adhesive small bowel obstruction, which are closely linked conditions. Up to 25% of patients with chronic adhesion-related pain experience episodes of adhesive obstruction.[3] Pain is thought to result from restricted visceral mobility, which stimulates visceral stretch receptors and nociceptive nerve fibers within the adhesions. When adhesions tether abdominal organs to each other or the abdominal wall, they may obstruct the bowel, often necessitating hospitalization and, in some cases, surgical adhesiolysis, the surgical dissection of the fibrous bands, to relieve obstruction.[6] Management of adhesion-related complications relies on careful clinical judgment. Diagnosis is guided by a thorough history, physical examination, and, when appropriate, imaging or laboratory investigations. Nonsurgical strategies remain the first-line approach, with surgical adhesiolysis reserved for patients who fail conservative measures or present with acute obstruction or other severe complications.[7]

Adhesiolysis—whether performed laparoscopically or through an open approach—carries significant risks arising from both the underlying disease process and the procedure's technical challenges. Complications are typically classified as intraoperative or postoperative. Intraoperative Complications Enterotomy or serosal injury Inadvertent bowel injury occurs in up to 10% of patients undergoing adhesiolysis.[16] These injuries may result in leakage of intestinal contents into the operative field, leading to intra-abdominal abscesses or surgical site infection, which can prolong hospitalization, increase the cost of care, and contribute to higher overall morbidity and mortality. Early or, ideally, intraoperative identification of any injury is crucial to prevent downstream complications. Bleeding and vascular injury Injury to mesenteric or abdominal wall vessels can occur, particularly when adhesions are dense or matted. Prompt recognition and meticulous hemostasis are essential. Thermal injury Electrosurgical or ultrasonic devices may cause lateral thermal spread, creating delayed bowel perforation if not used with caution. Conversion to open surgery Laparoscopic procedures may require conversion (historically 32%–38%) because of poor visualization, uncontrolled bleeding, or unexpected findings.[14] Early Postoperative Complications Bowel obstruction or ileus May arise from residual or newly formed adhesions or postoperative edema Intraabdominal sepsis Often a consequence of missed enterotomy or anastomotic leak if bowel resection was performed Hemorrhage or hematoma formation Wound complications Infection, dehiscence, or incisional hernia, particularly after open surgery. General postoperative complications Patients are susceptible to deep vein thrombosis (DVT), atelectasis, surgical site infection, and urinary tract infection. Prophylactic measures—including incentive spirometry, pharmacologic or mechanical DVT prophylaxis, and timely removal of Foley catheters—are essential to reducing these risks. Late Complications Recurrent adhesions and obstruction Although results from newer studies indicate that adhesiolysis does not inevitably lead to recurrent bowel obstruction, adhesions can reform and remain a source of future obstruction or pain.[10] Chronic abdominal or pelvic pain Symptoms may persist or recur despite technically successful surgery. Incisional hernia Particularly after midline laparotomy. Strategies to Mitigate Risk

Although results from newer studies indicate that adhesiolysis does not inevitably lead to recurrent bowel obstruction, adhesions can reform and remain a source of future obstruction or pain.[10] Chronic abdominal or pelvic pain Symptoms may persist or recur despite technically successful surgery. Incisional hernia Particularly after midline laparotomy. Strategies to Mitigate Risk Preventing complications begins with careful patient selection and meticulous surgical technique, including sharp dissection within anatomic planes and cautious use of energy devices. Early recognition of intraoperative injuries, especially enterotomy, is critical to minimize morbidity. Postoperatively, structured protocols for prophylaxis and surveillance, such as early ambulation, respiratory exercises, and infection prevention strategies, are essential to enhance patient safety and optimize outcomes.

Patients undergoing adhesiolysis require a highly coordinated, interprofessional approach to treatment, ensuring patient-centered care, optimizing outcomes, and maintaining safety. Clinicians, particularly surgeons, must integrate advanced technical skills in minimally invasive and open techniques with sound perioperative decision-making, selecting appropriate candidates, and determining the safest operative approach. Advanced clinicians, such as physician assistants and nurse practitioners, play a key role in preoperative evaluation, patient education, and postoperative monitoring, reinforcing instructions regarding early ambulation, diet advancement, and warning signs of complications. Nurses provide continuous bedside assessment, facilitate early detection of postoperative issues such as ileus or infection, and coordinate timely interventions. Pharmacists contribute by reviewing and optimizing perioperative medications, managing analgesia to reduce opioid exposure, and advising on prophylactic agents when antiadhesive barriers or adjunctive pharmacologic therapies are considered. Clear, structured communication among all team members is critical to maintain patient safety and improve outcomes. Preoperative briefings and multidisciplinary rounds promote shared situational awareness, while standardized handoff tools and postoperative care pathways ensure that all professionals understand the surgical findings and anticipated recovery trajectory. Dietitians and physical therapists may be engaged to expedite nutritional recovery and early mobilization, which are central to enhanced recovery protocols. By fostering open communication, defining roles, and aligning goals of care, the interprofessional team can reduce complications, improve patient satisfaction, and enhance overall team performance in the complex care of patients requiring adhesiolysis.