Readhesions

Readhesions are the re-formation of fibrous bands between tissues in the peritoneal cavity after prior adhesion lysis or abdominal or pelvic surgery. Like primary adhesions, readhesions can tether organs and disturb normal movement, and they may cause symptoms ranging from none to significant pain or obstruction. A history of prior adhesiolysis or surgery is a key feature that distinguishes readhesions from first-time adhesions, although it does not predict exact location or severity.

Causes and risk factors: Readhesions arise when the peritoneum heals after inflammation or trauma. Recurrent inflammation, infection, endometriosis, or contamination during surgery can promote adhesion re-formation. Risk factors include any previous abdominal or pelvic surgery, longer operative times, extensive tissue handling, and inadequate hemostasis. Reoperations in the same region carry especially high risk.

Clinical features and complications: Readhesions can produce chronic pelvic or abdominal pain, intermittent obstruction, or, in women, infertility or recurrent ectopic pregnancy. Acute adhesive small-bowel obstruction is a potential emergency, presenting with nausea, vomiting, abdominal distension, and failure to pass gas or stool.

Diagnosis: Diagnosis relies on history and imaging when obstructive symptoms are present. CT scanning is commonly used to identify obstruction; MRI may help in specific settings. Diagnostic laparoscopy remains the gold standard for confirming readhesions and for therapeutic adhesiolysis when indicated.

Treatment and prevention: For obstruction, management may require hospitalization and surgery to release adhesions. Conservative strategies are used for mild symptoms. Recurrence after adhesiolysis is common. Prevention focuses on minimizing peritoneal trauma, using meticulous technique, maintaining moist tissues, and applying adhesion barriers or gels when appropriate.

Prognosis: Readhesions carry a substantial risk of recurrence and obstruction. Ongoing research aims to improve prevention and reduce recurrence with barrier materials and pharmacologic approaches.