This paper reviews a near half century of interest and personal involvement in the topic of intra-abdominal adhesions. During this time, much has been learned about the aetiology of this condition, which results from the presence of ischaemic or foreign material in the peritoneal cavity. This knowledge, in turn, has led to modifications in our operative practices. While for many years a rather neglected subject, recent studies have stressed the complications that may result from adhesions, in particular small bowel obstruction, and have documented the clinical burden of adhesions on the health services. For over a century, surgeons have investigated means of preventing or at least modifying the formation of adhesions. At first, these were carried out in a quite arbitrary manner, but in more recent times, there has been a more rational approach, based on our clearer knowledge of their aetiology.