How common are adhesions after laparoscopic surgery?

September 22, 2025 •

4 min read

While adhesions occur in over 90% of patients following traditional open abdominal surgery, the risk is significantly lower with minimally invasive approaches. Understanding how common are adhesions after laparoscopic surgery is crucial for managing patient expectations and mitigating potential complications.

Quick Summary

Adhesion formation is less frequent after laparoscopic surgery compared to open procedures, occurring in an estimated 54% to 70% of patients versus over 90% in open surgery. Many adhesions remain asymptomatic, though the overall long-term burden associated with complications like chronic pain and bowel obstruction remains a concern.

Key Points

Prevalence: Adhesions occur in an estimated 54–70% of laparoscopic surgeries, which is a significant reduction from the over 90% rate seen in open procedures.
Symptom Burden: The majority of adhesions that form after laparoscopic surgery are asymptomatic; only a small subset of patients develop complications like chronic pain, infertility, or bowel obstruction.
Risk Factors: Risk of adhesions increases with the number of prior abdominal surgeries, underlying inflammatory conditions like endometriosis, and surgical factors such as tissue handling.
Prevention: Strategies to prevent adhesions include using minimally invasive techniques, meticulous surgical skill, and the application of bioresorbable adhesion barriers during surgery.
Management: Treatment for symptomatic adhesions, known as adhesiolysis, typically involves repeat surgery, but this carries its own risk of forming new adhesions and is reserved for significant complications.

Understanding the Biology of Surgical Adhesions

Surgical adhesions are fibrous bands of scar tissue that can form in the abdominal or pelvic cavity following a procedure. They are a natural part of the body's healing process, but when they cause adjacent organs to stick together, they can lead to complications. The process begins with tissue trauma, which triggers an inflammatory response. The body releases fibrin, a protein that forms a temporary mesh to stop bleeding and protect the area. Normally, this mesh is broken down by the body's natural fibrinolytic system. However, if the process is disrupted or healing is extensive, the fibrin can be reorganized into a permanent fibrous band, creating an adhesion.

The Prevalence of Adhesions after Minimally Invasive Procedures

Though less common than with open surgery, how common are adhesions after laparoscopic surgery depends heavily on the specific procedure and other individual risk factors. Studies have shown a significant reduction in the incidence of adhesions when using a laparoscopic approach over open surgery. For instance, some research indicates a 45% reduction in adhesion formation risk with laparoscopy. However, as minimally invasive as it is, laparoscopy still involves tissue manipulation and inflammation. Estimates suggest adhesions still form in roughly 54% to 70% of patients who undergo laparoscopic procedures, compared to over 90% in open surgery. It's important to remember that most of these adhesions are asymptomatic, and only a small percentage ever lead to clinical problems requiring further intervention.

Procedure-Specific Adhesion Rates

Prevalence varies widely by the type and extent of the surgery. For example, adhesion-related readmissions after a laparoscopic appendectomy may be as low as 0.8%, while colorectal surgery may see rates up to 2.5%. Gynecological procedures, particularly those involving the ovaries or uterus like myomectomy, carry a significant risk, even laparoscopically, with some studies reporting rates as high as 70%. Endometriosis is another risk factor that significantly increases the likelihood of adhesion formation, as both the disease and the subsequent surgery contribute to tissue trauma and inflammation.

Comparing Adhesion Risk: Laparoscopic vs. Open Surgery

Minimally invasive surgery's smaller incisions and reduced tissue handling are key reasons for the lower adhesion risk compared to traditional open surgery. The table below outlines some of the primary differences impacting adhesion formation.


Feature	Laparoscopic Surgery	Open (Laparotomy) Surgery
Incision Size	Several small incisions	One large incision
Tissue Exposure	Minimal exposure to air and external contaminants	Widespread exposure, leading to desiccation and cooling
Tissue Handling	Gentle, instrument-based manipulation	Direct, manual manipulation of organs
Foreign Body Risk	Reduced risk from powder, lint, etc.	Higher risk from glove powder and other materials
Inflammatory Response	Generally milder inflammatory response	More pronounced inflammatory response
Postoperative Pain	Less post-operative pain	More significant post-operative pain
Adhesion Rate	Lower incidence (approx. 54-70%)	Higher incidence (often over 90%)

Recognizing Symptoms and Complications of Adhesions

While many adhesions are benign, they can lead to significant problems if they bind to organs like the intestines, ovaries, or uterus. Symptoms, if they occur, can emerge weeks, months, or even years after the initial surgery.

Chronic Pain: Adhesions can cause chronic abdominal or pelvic pain, which may be dull, cramping, or sharp. The severity of the pain does not always correlate with the extent of the adhesions.
Bowel Obstruction: This is one of the most serious complications, occurring when adhesions twist or kink the intestines, blocking the passage of food and waste. Symptoms include severe abdominal pain, bloating, nausea, vomiting, and inability to pass gas or stool. A bowel obstruction is a medical emergency.
Infertility: In women, adhesions can distort the anatomy of the reproductive organs, blocking fallopian tubes or interfering with the movement of the uterus and ovaries, which can lead to infertility.

Strategies for Prevention and Management

Surgeons can employ several strategies to minimize the risk of adhesions during laparoscopic procedures. These include:

Meticulous Surgical Technique: Adherence to the principles of minimally invasive surgery, such as gentle tissue handling, precise hemostasis (controlling bleeding), and avoiding tissue desiccation, is critical. The use of warmed, humidified CO2 during insufflation can help maintain the health of the peritoneal surfaces.
Adhesion Barriers: Several types of bioresorbable barriers are available to place between tissue surfaces to prevent them from adhering during the healing phase. These come in film, gel, or solution forms. Examples include hyaluronic acid/carboxymethylcellulose (Seprafilm) and icodextrin (Adept), though their suitability varies by procedure.
Early Mobilization: Postoperative physical therapy and gentle movement can help prevent organs from settling and adhering.

Management of symptomatic adhesions typically involves another surgical procedure, known as adhesiolysis, to cut and separate the fibrous bands. However, this is a delicate balance, as subsequent surgery can cause new adhesions to form. For this reason, a physician may only recommend adhesiolysis if the patient is experiencing significant, life-altering symptoms like a bowel obstruction. For most asymptomatic cases, observation is the standard approach.

Future Directions in Adhesion Prevention

Ongoing research continues to explore new methods for preventing adhesions. This includes investigating new biomaterials for adhesion barriers, pharmacologic interventions targeting inflammation, and a better understanding of the genetic predispositions that may increase an individual's risk. This research offers hope for more effective strategies in the future.

Conclusion

While laparoscopic surgery significantly reduces the incidence of adhesions compared to open procedures, the risk is not eliminated. A substantial percentage of patients will still form adhesions, although most will not experience symptoms. Understanding how common are adhesions after laparoscopic surgery and the steps taken to prevent them empowers patients to have a more informed discussion with their healthcare providers. Effective prevention relies on meticulous surgical technique and, in high-risk cases, the use of adhesion barriers. The decision to treat symptomatic adhesions surgically must be carefully weighed against the risk of creating new adhesions. As surgical techniques and preventative materials evolve, patient outcomes will continue to improve. To learn more about abdominal adhesions and related conditions, visit Cleveland Clinic.

Frequently Asked Questions

Many adhesions are asymptomatic. When symptoms do occur, they can include chronic abdominal or pelvic pain, bloating, constipation, or, in severe cases, signs of a bowel obstruction like intense cramping, nausea, and vomiting.

No, laparoscopic surgery significantly reduces the risk of adhesion formation compared to open surgery, but it does not eliminate it entirely. The risk is still present, though a lower percentage of cases result in symptomatic adhesions.

Most adhesions are not visible on standard imaging like X-rays or CT scans unless they cause a complication like a bowel obstruction. A definitive diagnosis often requires a diagnostic laparoscopy, which allows a surgeon to directly visualize the adhesions.

Yes. While adhesions can form in the weeks and months following surgery, complications can arise years later. It is possible for an adhesion to remain dormant and then cause an issue much later by entrapping or twisting an organ.

Yes, the type of procedure, location of the surgery, and extent of tissue trauma all play a role. For example, certain gynecological procedures, especially those involving the ovaries or uterus, and surgeries with extensive inflammation are associated with higher adhesion rates.

An adhesion barrier is a product, such as a film or gel, that a surgeon places inside the body during surgery to separate healing tissues. It acts as a temporary protective layer that allows the tissues to heal without sticking together. These barriers are typically bioresorbable and dissolve naturally over a few weeks.

Not necessarily. If adhesions are asymptomatic or cause only minor, manageable discomfort, no intervention may be needed. Surgery is usually reserved for cases where adhesions cause serious complications like a bowel obstruction or significant chronic pain.