Surgical Adhesions from Gynecologic Surgery

Adhesions form as a result of injury or trauma to the peritoneum, the clear membrane that covers the inside of the abdomen and all abdominal and pelvic organs, except the ovaries. When healthy, this membrane is slippery. Once injured, however, the immune system kicks in to repair things, leading to inflammation and the production of sticky scar tissue called a fibrin matrix.

Normally these bands of scar tissue dissolve through a biochemical process called fibrinolysis, just like a cut on your finger and any resulting scab eventually heal. But surgery reduces levels of blood chemicals needed for fibrinolysis, meaning these fibrous brands may not dissolve; instead, they develop into adhesions. They may form within a couple of weeks after surgery or not for months or even a year or more.

Although all gynecologic and abdominal surgeries can cause adhesions, cesarean sections, particularly repeat cesarean sections, carry a very high risk. One study found that women having their third or more cesarean section were almost twice as likely to experience dense adhesions as those undergoing their second (46.1 percent vs. 25.6 percent). Both groups, however, experienced a significant rate of adhesions.

Although many women develop adhesions after surgery and never know it, in some women adhesions can cause serious complications, including: