An adhesion barrier is an artificial substance, usually a gel or a film, that is placed on an organ over the internal incision created during surgery. The barrier prevents the organ from coming into contact with other organs or the interior of the cavity and forming scar tissue, called adhesions. Abnormal scar tissue can pull on the internal organs causing chronic pain, bowel obstructions, and infertility.
Adhesions are a common risk for any open surgery. Within three days, the healing tissue begins to knit together any surface that it touches. A new adhesion is formed in seven days. The internal scarring can cause extreme pain and necessitate another surgery to separate the adhesions. Proper surgical technique and the placement of an adhesion barrier may prevent the formation of adhesions.
Newly implanted adhesion barriers must not dissolve before the seven days has past, or new scar tissue will still be able to form. A barrier should be able to maintain its structural integrity even when saturated with blood or internal fluids. If the adhesion barrier fails before the first week, it is likely that scar tissue will develop.
The most common adhesion barrier used is a sticky film made of modified sugars that occur naturally in the body. After placement in the body, the film dissolves within two to three weeks. Another adhesion barrier is made of a material like Teflon®. It may need to be surgically removed after the healing period.
Some surgeons prefer to apply a gel-like substance to the surfaces of the organs to prevent adhesions from developing. Others simply use a lactate solution to fill the abdominal cavity. The liquid is thought to provide a barrier between the injured tissue and other internal surfaces.
Many adhesion barriers are made of oxidized regenerated cellulose, expanded polytetrafluorethylene, or a combination of sodium hylauronate and carboxymethlcellulose. One of these, the Interceed® adhesion barrier, is commonly used for gynecological operations. This cloth-like patch is used in cesarean sections to prevent the uterus from attaching to the fallopian tubes or the ovaries. It is not known how the barrier affects future pregnancies.
A Preclude Peritoneal Membrane® is made of expanded polytetrafluorethylene. It is used in cardiac surgeries to prevent adhesions forming that connect the heart to the peritoneal wall. A barrier made from this material does not dissolve. The barrier is meant to permanently stay in the body, and eventually it will be encapsulated as part of the healing process.
Surgical removal of the adhesion may be the best option for some people. The operation is called an adhesiolysis. Scar tissue is severed from the organ or cavity it has grown into, and a new adhesion barrier is implanted. There is a possibility that the adhesions will form again post-operatively, causing a need for treatment to begin again.
