Surgical adhesions - internal bands of scar tissue that form between organs or tissues after surgery- can lead to severe complications such as bowel obstructions, chronic pain, and infertility while increasing the difficulty of future operations.
Surgical adhesions negatively impact patient outcomes and drive up health care costs.
There is currently no standard measure of the severity of surgical adhesions or their impact on a patient's quality of life.
CHICAGO - Scarring is expected after most operations, but surgical adhesions present a unique challenge for patients and surgeons. These internal bands of scar tissue can bind organs to each other or to the wall of the abdomen, causing major problems such as bowel obstructions, chronic pain, and fertility challenges. These effects increase costs for patients and health care systems alike.
Abdominal adhesions develop in over 90% of patients after undergoing open abdominal surgery, 66% of patients after gastrointestinal surgery, 51% after obstetric and gynecological surgery, and 22% after urological surgery. For conditions where repeated abdominal surgeries are common, such as Crohn's disease and ulcerative colitis, surgical adhesions present a consistent risk.
A group of international experts convened in Washington, D.C., in September 2024 for the American College of Surgeons (ACS) Surgical Adhesions Improvement Project Summit to explore the challenges of surgical adhesions in depth and identify future solutions. Proceedings from the Summit are published in the Journal of the American College of Surgeons .
A Call for Standardization and Innovation
One persistent problem in addressing surgical adhesions is the lack of standardization. There is no universally accepted method to measure surgical adhesions or assess their severity. Current treatment options also lack consensus on the best practices for their use.
"Surgical adhesions are a silent epidemic," said Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, Senior Vice President for the ACS Division of Research and Optimal Patient Care. "They affect millions of patients worldwide, yet we still lack standardized tools to measure their impact and guide treatment. This summit, and our ACS improvement project, mark a critical step toward unifying our approach and developing innovative solutions to reduce the burden of adhesions on patients and health care systems."
A portion of the summit was dedicated to understanding the exact molecular and genetic mechanisms that lead to surgical adhesions. By uncovering how these adhesions form, researchers hope to develop more effective treatments.
Glimpses of Hope in Prevention and Diagnosis
The literature review presented at the summit highlighted some promising advancements. For example, the use of adhesion barriers was associated with a reduction in small bowel obstruction. However, experts agreed that further high-quality research and standardized practices are needed to optimize the use of these prevention tools in clinical settings.
While minimally invasive techniques reduce the incidence of surgical adhesions when compared to open surgery, nearly 30% of patients will be readmitted within five years of their first abdominal or pelvic surgery for surgical adhesion-related issues, primarily small bowel obstruction.
A new diagnostic approach, cine MRI, offers hope for noninvasive detection of adhesions. This advanced imaging technique assesses restrictions in bowel movement caused by adhesions, providing clinicians with a clearer picture of the extent of adhesive disease.
Future Directions: Personalized Medicine and Beyond
Future research areas include the role of the microbiome in adhesion formation and investigating the use of stem cells to influence healing responses. Personalized medicine could also play a key role in prevention, tailoring treatments to patients' individual genetic and molecular profiles.
"The future of adhesion prevention lies in understanding the unique biological pathways that drive their formation," said Samuel P. Carmichael II, MD, FACS, a trauma surgeon at Wake Forest University School of Medicine and one of the event's key organizers. "By combining innovative technologies like hydrogels with targeted molecular therapies, we can move closer to a future where adhesions no longer routinely create complications."
FDA representatives at the summit guided experts through the regulatory process to ensure that any newly developed prevention or treatment products could be safely and efficiently introduced to the market.
This summit and the Surgical Adhesions Improvement Project are possible through the generosity of Peter Carlino and his wife, Marshia. The Carlino family are committed philanthropists in medical research and patient care advancements. Their generous $1 million donation underscores their dedication to confronting formidable health care challenges and their enduring support for clinical and scientific excellence.
One of the first steps to fully understanding the impact of surgical adhesions is developing a method to measure them. Experts from the summit are currently working on creating a standardized adhesion scoring system and a method to collect data on patients' perspectives regarding their symptoms and quality of life.
Study coauthors with Dr. Ko and Dr. Carmichael are: Dana Andersen, MD; David Wiseman, PhD, MRPharmS; Deshka Foster, MD, PhD; Eric Appel, PhD; Jessica Cardenas, PhD; Joel Zindel, MD, PhD; Melinda Maggard-Gibbons, MD, MSHS, FACS; Richard PG ten Broek, MD, PhD; Rudy Leon De Wilde, MD, PhD; Steven Bauer, PhD; Steven Mutsaers, PhD; Tara Russell, MD, PhD, MPH, FACS; Tess C. Huy, MD; Timothy Donahue, MD, FACS; Walter Koltun, MD, FACS; Yuval Rinkevich, PhD.
This study is published as an article in press on the JACS website and is the result of the American College of Surgeons (ACS) Surgical Adhesions Improvement Project Summit hosted in Washington, D.C. from September 19-20, 2024.
Disclosure: Nothing to disclose. Dr. Zindel is supported by the Swiss National Science Foundation. Drs. Russell and Huy received support from the American College of Surgeons.
Citation: Andersen D, Wiseman D, Foster D, et al. Proceedings of the American College of Surgeons Surgical Adhesions Improvement Project Summit. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001358
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
