Bands, Adhesions or Synechia?

The terms band and adhesion, used interchangeably in the surgical field, create confusion. The precise use of language is fundamental for teaching and the development of our profession and science. The purpose of this paper is to discuss their correct usage. The Spanish word for band is brida (band) is taken from the French bride, and in turn from the Germanism bridel (“brit’l” or “brîtil”). In contrast, adhesion comes from the late Latin “adhaerentia” [ad “next to”+haerē (re) “adhere”+-ntiam “action of”]. Synechia has its exclusive origin in ancient Greek [sýn σύν gr. “with”, “union”+ekh- Ḕχω gr. “to have”, “to be in touch”+-e-ia]: synekheia (συνὲχɛια). The latter is, therefore, the most archaic term of the 3.^1–3 A band is a vascularized fibrous tissue that joins serous organic surfaces covered by epithelia (peritoneum). Its formation is a consequence of fibrin organized in the form of fibrous connective tissue. It facilitates the adhesion between the structures covered by a serous membrane that, under normal conditions, are not adhered.¹

An adhesion is the physical union or sticking; the quality of being adherent. It is the abnormal or pathological union between two anatomical structures that are normally separated. It is a more generic term.¹Synechia is the existence of continuity between two structures, and the adherence between their proximal parts.¹ It is, therefore, even more generic and would encompass the previous 2 terms. The Spanish term for band, brida (bridle), is borrowed from equitation. It refers to the set of leather bands and straps that hold the bit, whose aim is to control and stop the horse. In medical usage, the term appeared in the translations of the book Aphorisms of Hippocrates. In Spanish, was first used in 1293^4,5 to refer to the membranous filaments that form in wounds and abscesses, hence the term to debride: “undo the bridles”.³ Special mention should be made of the angiomesenteric or Harris band: it is a peritoneal fold extending from the gallbladder and the cystic duct, crossing the anterior side of the duodenum.²

The term adhesion refers to the adherence, fixation or physical and pathological union between 2 elements.^1,2 The term adherencia appears used in Spanish for the first time in 1340.^3,5 Its use is therefore more generic and later, although we can see it in very specific terms such as: adherencia ática which is the adhesion around the gallbladder and pyloric region; or adherencia epitelial between the gums and teeth.^2,3,5Synechia is a term borrowed from the railroad as synonymous with the splice bar or fishplate, which is the link between the rail sections. In plumbing, it is the connecting element between pipes. It was widely introduced in the medical language by contributions with the French synéchie in 1808. Currently, its use is applied to synechiae of the iris, either between the iris and the cornea (anterior) or the iris and lens (posterior). The terms vulval synechia, uterine synechia or balanopreputial synechia are also used. There is also nasal synechia, referring to the adhesion between the walls of the nasal fossa.² In short, although the 3 are complementary terms and synonyms in their daily use, we can conclude by saying that bands are the denomination for peritoneal adhesions, the latter being an anomalous type of synechia. The surgical act of dividing the bands is called band ablation/lysis. This is because the most frequently used term for them is bands. However, if we call them adhesions, the appropriate terms are adhesiotomy, adhesiolis or enterolysis. On the other hand, if we call them synechiae, the appropriate term would be synechotomy.^2,3 From a linguistic and normative standpoint, we should use the term band to designate an adhesion that causes bowel obstruction, reserving the term adhesion to describe the phenomenon of abnormal union between peritoneal surfaces. The term synechia would be equivalent, although it has fallen into disuse in surgery.

Acknowledgements

Thanks to Dr. J.A. Pereira Rodriguez and Dr. Silvia Valverde for reviewing this manuscript and sharing a love for the language.