Understanding the Long-Term Impact of Surgical Adhesions

Surgical adhesions—abnormal fibrous scars that form after surgery—remain one of the most underrecognized threats to long-term patient outcomes. Though commonly associated with orthopedic procedures like knee and shoulder surgeries, adhesions can also lead to severe complications such as infertility, chronic pain, and life-threatening bowel obstructions following abdominal or gynecological operations. Their delayed onset and subtle symptoms often lead to misdiagnosis or treatment delays, especially when patients seek care outside their original surgical team. In a conversation with Pharmaceutical Executive, Chris Springate, CEO of ARC Medical, shares how greater awareness, preventive strategies, and innovations like ARC’s JoCoat and IPCoat are helping surgeons reduce adhesion-related complications and improve recovery.

Pharmaceutical Executive: Surgical adhesions are often described as a "silent epidemic." Why do you think they have remained an underrecognized issue despite their widespread impact on patient outcomes?

Chris Springate: It’s a complex issue. One reason is that symptoms from surgical adhesions often don’t present until weeks or even months after surgery, which can make the connection less obvious.

To explain, surgical adhesions are internal scars—fibrous bands that form between tissues and organs after surgery. These aren’t the scars you want. For example, after gynecological procedures, some women develop a condition known as a “frozen pelvis,” leading to chronic pain and even infertility. In abdominal surgeries, adhesions can cause bowel obstruction or strangulation, which can be life-threatening and often require emergency surgery to correct.

Adhesions also occur after orthopedic procedures like knee replacements or ACL surgeries. Patients may lose range of motion—sometimes unable to extend beyond 90 degrees, making basic tasks or rehabilitation difficult. In orthopedics, there's more awareness due to active monitoring of joint stiffness using tools like goniometers.

In contrast, after gynecological or abdominal surgery, symptoms can emerge much later. Patients may present with pain in the emergency room and receive pain management without a proper diagnosis. It can take years before the root cause—adhesions—is identified. Surgeons may use ideal techniques, but the body’s inflammatory response can still lead to adhesions. And because patients often return to a different provider, the original surgeon may never see the long-term outcome.

We’ve seen some progress. About 85% of abdominal and gynecological surgeries are now done laparoscopically, with the hope that minimally invasive methods would reduce adhesion formation. However, adhesions still frequently occur—even with perfect surgical technique—suggesting we need continued innovation and awareness in this area.

Full Interview Summary: Surgical adhesions, which are abnormal fibrous scars that form inside the body after surgery, have often been overlooked despite their significant impact on patient outcomes. These adhesions can cause long-term complications, such as infertility following gynecological surgeries, chronic pain, and even life-threatening bowel obstructions after abdominal surgeries. While adhesions are well recognized in orthopedics, such as after knee or shoulder surgeries, their symptoms may take weeks or months to present, complicating diagnosis. Patients often visit emergency rooms, where different surgeons may provide varied treatments, leading to delayed or incorrect diagnoses.

Over the past 15 years, awareness among surgeons has increased, thanks to efforts from key opinion leaders in the field. Today, more surgeons are focusing on adhesion prevention, using techniques like minimizing operating time and applying barrier products, such as films, gels, or liquids, to reduce adhesion formation.

ARC's products, JoCoat and IPCoat, are liquid medical devices designed to prevent adhesions. JoCoat is used in knee and shoulder surgeries, while IPCoat is used in abdominal or gynecological surgeries. Both products contain a high-molecular-weight polysaccharide that forms a temporary, biodegradable physical barrier, preventing adhesion formation. This barrier is non-pharmacological and does not require degradation to work, classifying it as a medical device. Initial clinical results show that these products significantly improve patient outcomes by reducing stiffness and increasing range of motion post-surgery. Surgeons have reported that the application of these products is quick and easy, with the potential to improve recovery and reduce complications related to adhesions.