Enemy of Mortality: Peritoneal adhesions

Postsurgical adhesions severely affect the quality of life of millions of people worldwide. Numerous attempts have been made to prevent or reduce the incidence of peritoneal adhesions, but with limited success.

Reoperating through a previous wound can be extremely difficult, risky, and potentially dangerous. Also, adhesiolysis extends operating time, anesthesia, and recovery time and causes additional risks to the patient such as blood loss, visceral damage including injury to the bladder, enterocutaneous fistulas, and resection of damaged bowel.

Congenital or inflammatory adhesions rarely give rise to intestinal obstructions, except for malformation. However, between 49 and 74% of the small bowel obstructions are caused by post surgical adhesions.4, 17, 18 Small bowel obstructions from adhesions are responsible for a large proportion of general surgical admissions and unavoidable operations in current surgical practice. Approximately 1% of all surgical admissions and 3% of lsaparotomies are the result of intestinal obstruction due to adhesions. In pediatric patients bowel obstruction from adhesions is most prevalent; 8% of neonates undergoing abdominal surgery require a future laparotomy for this complication.

Strategies to reduce adhesion formation include improving surgical techniques, optimizing laparoscopy conditions, using pharmacologic interventions targeted at the inflammatory response and/or fibrin deposition, and using agents that provide a physical barrier to adhesion formation. While these strategies have provided some success, none have yet proved totally successful in abolishing adhesions. Further research to ensure that adhesion prevention is optimal is therefore essential.

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