Peritoneal adhesions in human and veterinary medicine: from pathogenesis to therapy. A review

Abstract

Any peritoneal inflammatory process consequent to infections or surgical injuries may induce abdominal adhesion formation. Peritoneal adhesions are connective laciniae that develop among abdomino-pelvic organs that limit physiologic visceral motion. Consequently, fertility may be impaired, and intestinal obstruction and pelvic pain may develop, mainly in subjects that had undergone gynaecological surgery. This review illustrates the pathogenic steps of adhesiogenesis and the therapeutic scenario that evolved over the years to tackle the threat of peritoneal adhesions, both in domestic animals and in women.

Effect of Hyaluronic Acid/Carboxymethylcellulose and Flunixin Meglumine Combination on the Prevention of Postoperative Intraabdominal Adhesions: An Experimental Study in Rabbits

“…Postoperative adhesions are considered to be an inevitable result of surgery. The incidence of postoperative adhesion ranges from 66 to 93% after operations [1][2][3] . Surgical trauma, tissue ischemia, hemorrhage, infection, and foreign materials play an important role in etiology of postoperative adhesions.…”

“…In developed countries, HA/CMC is accepted as an important antiadhesive barrier. Unfortunately, none of these treatments is ideal [1][2][3]5,8,9,[14][15][16] .…”

“…Early fibrinolysis, within 5 days, encourages healing of the peritoneum without adhesion formation. Inadequate fibrinolysis processes lead to persistent fibrin structures that subsequently mature into fibrous tissue, followed by organization into rigid, persistent fibrous adhesions containing blood vessels and nerve fibers [1][2][3][4][5][6] .…”

“…Postoperative intraabdominal adhesions cause chronic abdominal/pelvic pain, female infertility, and small bowel obstruction. Also, fibrous adhesions make prolong operation time, operation difficulty, increased bleeding, intestinal rupture, and morbidity in repeated operations [1][2][3][4][5].…”

“…Many different techniques, agents, and materials have been tried to reduce adhesions [1][2][3][6][7][8][9] . Several pharmacological drugs including corticosteriod, non-steroid antiinflammatory drugs (NSAIDs), melatonin, progesterone, aprotinin, methylen blue, heparin, mitomycin C, vitamin E, and tPA have been used to prevent adhesions [1,2,8,10,11] .…”