Overview
Untangling scar tissue. Restoring flow.
Adhesions are internal scar bands that form between loops of bowel and the abdominal wall after surgery, infection, or inflammation. Most adhesions never cause symptoms. In a subset of patients, adhesions kink or constrict the small intestine, producing recurrent small bowel obstruction — the cramping pain, vomiting, and inability to pass gas that brings patients to the emergency room. When obstruction won't resolve on its own, or when episodes recur, the answer is surgical lysis of the offending adhesions.
We do most elective adhesiolysis cases minimally invasively — laparoscopic or robotic — for patients whose imaging suggests focal adhesions and whose abdomen is not hostile to safe entry. Open surgery is the right choice when prior operations have created dense diffuse adhesions, when the bowel is clearly compromised, or when the patient is too unstable to tolerate a prolonged minimally invasive operation. Either way, the goal is the same: identify and divide the obstructing bands, confirm the bowel is healthy, and avoid creating new injuries.
Who is a candidate?
Most patients with a history of small bowel obstruction after prior abdominal surgery are candidates for adhesiolysis — particularly when episodes recur, when conservative management fails, or when imaging shows a clear focal transition point. Patients with chronic abdominal pain alone (without evidence of obstruction) are generally not good candidates — adhesiolysis is unreliable for chronic pain because adhesions reform. Emergency surgery is required for closed-loop obstruction or signs of ischemic bowel.
How we perform it
Under general anesthesia, the abdomen is entered carefully — often at a site away from prior scars to find a safer entry plane. Adhesions are divided using a combination of blunt dissection, scissors, and energy devices. The entire length of the small bowel is inspected from one end to the other to identify the obstructing band and confirm there are no others. If a segment of bowel is damaged or ischemic, it is resected and the healthy ends are reconnected. Operation length varies enormously — from 90 minutes to over 5 hours depending on severity.
Recovery
Recovery depends on whether bowel was resected. Simple adhesiolysis without resection: 2–3 day hospital stay, diet advance over the first few days, home and back to activity within two weeks. Adhesiolysis with bowel resection: 4–5 day stay, slower diet advance. We use the same ERAS principles as for colon surgery — early ambulation, minimal IV fluids, multimodal pain control. Most patients are back to baseline within 4–6 weeks.
Why Florida Surgical
Adhesiolysis is a deceptively difficult operation. Entering safely, identifying the right band, and not creating an enterotomy (an unintended hole in the bowel) all matter — and outcomes are tightly linked to surgeon experience with reoperative abdominal surgery. Dr. Shaw and Dr. Decio do this work routinely, including minimally invasive adhesiolysis in patients whose prior surgeons believed only open surgery was possible. We coordinate with the patient's gastroenterologist and primary care doctor on long-term management.
Frequently asked questions
Will my adhesions come back after surgery?
Some always reform — that's the natural healing response. Whether they cause obstruction again depends on the location and tightness of the new adhesions. Most patients who have adhesiolysis for recurrent obstruction do well long-term, but a minority have repeat obstructions over the years.
How can I tell if I'm having an obstruction?
The classic combination is cramping abdominal pain, vomiting, abdominal distension, and inability to pass gas or stool. If you have these symptoms, especially after prior surgery, come to the emergency room or call our office — we'd rather see you early.
Can adhesions cause chronic pain?
It's controversial. Some patients do have pain from adhesions, but operating for chronic pain alone is unreliable — adhesions reform and pain often persists. We are honest about this in the office.
Is robotic adhesiolysis safer than open?
For appropriately selected patients, yes — less wound complications, less pain, faster recovery. The trade-off is that minimally invasive adhesiolysis is technically demanding; the patient selection matters.
Can I prevent adhesions from forming after surgery?
Some bioabsorbable barriers (like Seprafilm) reduce adhesion formation in select operations. They're not used routinely. The strongest prevention is good surgical technique — gentle handling of tissue, minimal foreign material, careful hemostasis.