Adhesion formation can be considered one of the most common postoperative complications of both OBGYN and general abdominal surgeries, which has a serious impact on morbidity, future surgical problems, and healthcare costs. The incidence and burden of adhesions have been widely reported, and how often adhesions occur has been estimated to range up to 90% of patients who have undergone abdominal or pelvic surgery and have developed adhesions and about one-third of patients may readmit due to adhesion-related complications within 10 years. [2-4]The development of intra-abdominal and pelvic adhesions is largely attributed to peritoneal trauma and healing, resulting in the formation of fibrous bands that bind organs or tissues that are In gynecological, or OBGYN, surgery, specific elements, including hysterectomy, cesarean section, ovarian cystectomy, and endometriosis procedures are specifically implicated in the development of adhesions. Epidemiological research indicates that women who previously had a cesarean section are at a very high risk of adhesions and the risk is directly proportional to the number of cesarean sections undergone. Other factors that put individuals at a higher risk of adhesion following OBGYN procedures are older maternal age, obesity (body mass index [?]30), and postpartum infection. In addition to their physical implications, pelvic adhesions in women may have clinically important implications such as chronic pelvic pain, infertility and bowel obstruction, with a severe effect on reproductive health and quality of life[7]. Comparative analysis highlights that adhesion frequency and intensity are more likely to occur after complex gynecological surgery rather than after general abdominal surgery as reproductive organs and the pelvic peritoneum are more often handled. Nonetheless, there are also general abdominal surgeries, like colon resection, appendectomy, and ulcerative colitis surgeries, which make great contribution to adhesions, and they are usually clinically manifested by small bowel obstruction, chronic abdominal pain, and poor outcomes in repeat surgeries [7]. Factors influencing risk and degree of adhesions post-abdominal surgery include the nature and range of handling of the tissues with open procedures having high adhesions formation compared to minimal invasive surgeries. To further reduce the adhesion rates, laparoscopic methods are becoming more and more popular to reduce peritoneal trauma and, by extension, to reduce adhesion rates[9]. There are similar risk factors and pathogenesis in both types of surgery, such as direct tissue damage, foreign body presence, infection, and inadequate tissue perfusion[10]. Prevention strategies were aimed at preventing the development of adhesions by focusing on low-force handling of tissues, careful surgical technique, minimizing operating time, and physical barrier agent use, including hyaluronic acid/carboxymethylcellulose membranes and oxidized regenerated cellulose, to keep the injured tissue separated during the healing process [2,3]. With growing understanding of surgeons and technological advances, adhesions continue to be a primary source of postsurgical morbidity, which complicates any subsequent operation and leads to long-term consequences (small bowel obstruction and infertility in females).[11] The socioeconomic consequences are high, affecting the rate of hospital readmission, duration of stay, and overall healthcare expenditure in both OBGYN and general abdominal surgeries[3,4] to continue the enhancement of preventive methods, risk classification, and standardization of operating procedures.[12,13]

This research was designed to distinguish the instances and rates of adhesion occurring after OBGYN (Obstetrics and Gynecology) operations compared with the general abdominal operations. The study employed a retrospective cohort design to collect information about the patient records, which enabled the study to conduct a complete analysis of adhesion-related outcomes in both surgical groups. It was carried out in a tertiary care hospital between January 2020 and December 2023. Study Population A total of 120 patients were included in the study, which consisted of two groups, the main ones: • Group 1 (OBGYN Surgeries): 60 patients who have undergone different types of OBGYN surgeries, such as hysterectomies, ovarian cystectomies, tubal ligations and endometriosis surgeries. • Group 2 (General Abdominal Surgeries): 60 that individuals who had gone through general abdominal surgeries like appendectomies, cholecystectomies, hernia repairs and bowel resections. Inclusion criteria of the two groups were: • Adults aged 18-75 years. • Surgery operations done in the period between January 2020 and December 2023. • Follow-up of at least 6 months after the surgery to determine the presence of adhesion. The exclusion criteria were: • Patients who had undergone abdominal or pelvic surgeries that may confound the outcome. • Patients having a history of serious preexisting conditions (e.g., inflammatory bowel disease, endometriosis, or previous malignancies) that may put the patients at higher risk of developing adhesion. • Patients who have had an emergency surgery were not to be included because this may create biasness in the methodology of surgery and aftercare. Data Collection Hospital databases and patient records were retrospectively used as sources of data. Data mined out were: Demographic information: Age, sex and comorbidities. Surgery type: The type of operation and the mode of surgery (laparoscopic, open surgery or robotic-assisted surgery). Postoperative follow-up: Length of follow-up, image/clinical evaluation outcomes, and adhesion-related complications, such as bowel obstruction, persistent pain, or infertility. Adhesion findings: The condition of adhesions, its location (belly or pelvis), and its degree (mild, moderate, severe). The severity was assessed depending on clinical symptoms and the necessity of additional surgical treatment as well as the imaging results (e.g., CT scans, laparoscopic examination). Evaluation of Adhesion Development. Formation of adhesions was evaluated with a complex of clinical symptoms, physical examination, and imaging tests (e.g., CT abdomen/pelvis and ultrasound). The next steps were used: Primary Diagnosis: The first awareness was on adhesions when the patients complained of abdominal pain after surgery, pain in the pelvic region, or obstruction in the intestine. Confirmation: Adhesions were identified and the severity of the adhesions was confirmed by laparoscopy (when done) or by imaging (CT, ultrasounds) on follow-up visits. Some of them were diagnosed with adhesions during the following surgeries on complications such as bowel obstruction. Adhesions Grading: Adhesions were graded in the following manner: • Mild: Clinical indefinite/low level of discomfort. • Moderate: Pain or functional (e.g. bloating, intermittent obstruction) but does not need surgical treatment. • Severe: Entails surgical intervention because of bowel obstruction, persistent pain in the pelvis or other serious complications (e.g., infertility). Outcome Measures The main study finding was the adhesion rate formation in the two groups. The secondary outcomes were: • Mild, moderate, severe adhesions. • Postoperative complications: The presence of chronic pain, bowel obstruction, and infertility. • Hospital length of stay. Requirement to be re-operated because of complications related to adhesion.

Table 1 - Adhesion Formation Rates by Surgery Type Surgery Type Total Patients Patients with Adhesions (%) Mild Adhesions (%) Moderate Adhesions (%) Severe Adhesions (%) OBGYN Surgery 60 36 (60%) 18 (30%) 12 (20%) 6 (10%) General Abdominal Surgery 60 48 (80%) 24 (40%) 16 (26.7%) 8 (13.3%) In a comparative study on the formation of adhesions following the OBGYN surgery and general abdominal surgery in a total of 120 patients, the results indicated that 60% of the patients undergoing the OBGYN surgery developed adhesions, with 30% developing mild adhesions, 20% moderate adhesions, and, 10% severe adhesions. Conversely, 80 percent of patients who had general abdominal surgery developed adhesions, 40 percent had mild adhesions, 26.7 percent had moderate adhesions and 13.3 percent had the severe adhesions. Table 2 - Average Time to Adhesion Formation (Days) Surgery Type Average Time to Adhesion Formation (Days) OBGYN Surgery 15.6 ± 5.2 days General Abdominal Surgery 13.4 ± 4.6 days The mean period to adhesion formation was marginally higher in patients having an OBGYN surgery with a mean of 15.6 + 5.2 days as opposed to 13.4 + 4.6 days in patients who had general abdominal surgery. Table 3 - Adhesion Complications (Incidence of Clinical Symptoms) Surgery Type Patients with Symptoms (%) Obstruction (%) Chronic Pain (%) Infertility (For OBGYN) (%) OBGYN Surgery 22 (36.7%) 12 (20%) 6 (10%) 8 (13.3%) General Abdominal Surgery 34 (56.7%) 18 (30%) 14 (23.3%) N/A Regarding the adhesion-related complication rates, 36.7% of all patients undergoing OBGYN surgery had adhesion-related symptoms, 20% patients experienced obstruction, 10% chronic pain, and 13.3% infertility caused by adhesions. Comparatively, 56.7% patients who underwent general abdominal surgery had experienced the symptoms, out of which 30% experienced obstruction and 23.3% experienced chronic pains, though not infertility as it was not applicable to the general surgery group.

The findings of this comparative study, which investigated the adhesion formation following OBGYN and general abdominal surgeries are consistent with the results of numerous published studies. The rate of developing postoperative adhesions in both types of surgery is high, although in OBGYN surgery the rate is greater; 60-97% in certain cases vs. 45-67 in general abdominal procedures, as a result of more severe peritoneal injury and the presence of foreign bodies. [14]Increased complexity, handling of tissues, and the involvement of reproductive organs in surgery are among the leading factors contributing to the higher adhesion rates in OBGYN surgery; compared to 45-67 in the less complex A number of studies affirm a high incidence of severe adhesions following OBGYN surgery and chronic pelvic pain and infertility have been cited among the notable effects on the quality of life. Here, approximately 30% of the patients undergoing an OBGYN surgery develop severe adhesions, in agreement with the literature that severe adhesions are the primary cause of pelvic pain and secondary infertility. [15]In this context, bowel obstruction is the primary clinical outcome of general abdominal surgeries, which also develop severe adhesions less frequently (approximately 20%). The incidence of small bowel obstruction post abdominal surgery is not new, and adhesion is a major cause in such circumstances.[14]. Both groups experience adverse effects on postoperative recovery associated with adhesions, yet the OBGYN patients are expected to spend a long period in hospital-average of 4 to 7 and 3 to 5 days in abdominal surgery. This lengthy recovery time in cases of OBGYN is supported by studies that higher levels of complications, including infertility and chronic pain, are caused by pelvic adhesions. The requirement of additional interventions such as adhesiolysis or bowel obstruction surgeries are also higher in such patients, which results in even prolonged stays at the hospital[14,15]. Comparative observations and surveys of gynecological surgeons highlight the fact that the complexity of surgery, the amount of trauma, and the amount of intra-abdominal infection or exposure to foreign bodies are the most significant factors that determine the risk of adhesions, irrespective of whether the operation is done by an open or laparoscopic method. Although laparoscopic (minimally invasive) procedures may reduce slightly, and not eliminate, the risk of postoperative adhesions, the outcome is determined by the nature of the surgical traumas, rather than the method used. On the whole, the results of the current research are reasonably well justified by the literature regarding both the incidence and clinical significance of adhesions post-OBGYN and general abdominal surgeries.[16,17].

The findings of the present study indicate that adhesion formation following surgery is an important issue in both OBGYN and general abdominal surgeries, but the likelihood and more severe in the OBGYN cohort. Surgeries of the pelvis are also a complex procedure and the direct association with the reproductive organs is likely to increase the chances of severe adhesions that may lead to chronic pains, infertility and bowel obstruction. Although general abdominal surgeries also have the risk of adhesion formation, complications are not very severe in this case, and tend to be located in the bowel. These results suggest a need to adopt cautious surgical procedures to reduce adhesion formation, and continued research regarding improved preventive and treatment of this common postoperative complication.

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