What is stickiness? Why does stickiness occur?

There is a transparent membrane on the surface of the lining of the abdominal cavity and pelvic cavity called the peritoneum. The peritoneum is very thin and malleable, a bit like plastic wrap, covering the surface of the bladder, uterus, fallopian tubes and part of the intestines. Other organs, such as the ovaries, liver, gallbladder, stomach, spleen, and part of the intestines, are located on the medial peritoneum. The peritoneum has a lubricating effect and helps organs move smoothly.

If the peritoneum is damaged, sticking may occur during the healing process. Sticking is a band-like scar tissue that forms in the abdominal cavity and pelvic cavity to connect organs and tissues that should not be connected under normal conditions. Adhesive tissue may appear as a film or as thick fibrous. The most common cause of peritoneal injury is surgery, and in all abdominal and pelvic surgeries, surgical instruments are placed into the body to cut, touch, or manipulate the organ, making it almost impossible to avoid peritoneal injury. According to studies, approximately 93 percent of patients who undergo abdominal surgery develop stickiness [1].

What are the problems caused by post-operative sticking?

You may not know that you have a sticky. In most cases, stickiness is not an effect and is usually not diagnosed. However, sometimes stickiness can cause sequelae such as pain[2,3], infertility[2,4], small bowel blockage[2,3], and other diseases. Symptoms may appear immediately after surgery or may not appear until years later. In some cases, another surgery may be needed to remove the sticky tissue and improve the sequelae of the sticky.

1. Pain

Stickiness can cause pain during ovulation or sex. Adhesion will “tie” the organs, restricting the movement of the organs, causing abnormal nerve stretching and stimulation[2,3] in daily activities that would otherwise not cause pain, resulting in chronic abdominal and pelvic pain.

2. Infertility

Adhesion of the ovaries to the fallopian tubes is the main cause of infertility, preventing the egg from traveling along the fallopian tube to the uterus or preventing sperm from entering the fallopian tube. Approximately 20 to 40 percent of infertility cases are thought to be related to stickiness [5].

3. Intestinal blockage

The most serious sequelae of stickiness is intestinal blockage. It is a serious condition in which substances in the intestines are blocked in the digestive system due to stickiness, causing abdominal cramps, nausea, and vomiting. Hospitalization sometimes improves symptoms, but in some cases emergency handing is required [5]. According to research, 65~75% of cases of small intestine obstruction are caused[6,7] by sticking.

Learn how to fix it

How can I prevent sticking?

During the procedure, the surgical team will try to avoid unnecessary damage to the peritoneum and use anti-sticking products, which are necessary measures to reduce the chance of sticking [5]. Prevention is better than cure, and this phrase is particularly good for describing stickiness.

What are the products to prevent sticking?

There are several anti-sticking products on the market that form a barrier and separate organs within a few days after surgery.

Physicians have two types of anti-stick products to choose from: all-round anti-stick solution and local solid anti-stick solution.

1. All-round anti-sticking solution:

It will be left in the abdominal cavity for several days to allow all organs to repair themselves, and maintain a state of floating in the fluid to achieve a broad coverage effect [8]. The fluid is slowly absorbed by the body along with the peritoneal fluid already present in the abdominal cavity.

2. Local solid anti-sticking:

It consists of a film that is coated or sewn on the outside of the organ, which is slowly absorbed by the body, or a gel that is applied to the surface of the organ and absorbed over time to achieve the purpose of site-specific anti-sticking [8].

References

1.Menzies D, Ellis H. Intestinal obstruction from adhesions how big is the problem? Ann R Coll Surg EngI 1990; 72: 60-3.

2.Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update 2001; 7: 567-76.

3.Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynaecologic surgery: clinical significance, etiology, and prevention.

4.Mishell DR. Davajan V. Lobo RA.

5.Brown CB, et al.

6.Ellis H. Medicolegal consequences of postoperative intra-abdominal adhesions.

7.Ellis H. The magnitude of adhesion related problems.

8.Sutton C, Minelli L, Garcia E et al.