Postoperative Abdominal Adhesions: Clinical Significance and Advances in Prevention and Management

Abstract

Postoperative adhesions remain one of the more challenging issues in surgical practice. Although peritoneal adhesions occur after every abdominal operation, the density, time interval to develop symptoms, and clinical presentation are highly variable with no predictable patterns. Numerous studies have investigated the pathophysiology of postoperative adhesions both in vitro and in vivo. Factors such as type and location of adhesions, as well as timing and recurrence of adhesive obstruction remain unpredictable and poorly understood. Although the majority of postoperative adhesions are clinically silent, the consequences of adhesion formation can represent a lifelong problem including chronic abdominal pain, recurrent intestinal obstruction requiring multiple hospitalizations, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and no effective therapy. Despite recent advances in surgical techniques, there is no reliable strategy to manage postoperative adhesions. We herein review the pathophysiology and clinical significance of postoperative adhesions while highlighting current techniques of prevention and treatment.

Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface

“…Adhesions are responsible for the majority of bowel obstructions in the Western world [58]. For these reasons, postoperative adhesions remain one of the most challenging issues in surgical practice [59][60][61].…”

“…Adhesions are pathologic bands connecting adjacent structures [59]. Under normal conditions, the blood clot and the fibrinous connections formed after trauma to the peritoneal interface are lysed within a few days by fibrinolytic substances, resulting in the repair of the damaged area [32].…”

“…Inflammation at the site of injury can inhibit or delay this fibrinolytic activity through the release of plasminogen activator inhibitors (PAI-1 and PAI-2), leading to persistent fibrin deposits that become an insoluble network on which cells can migrate and proliferate [32,52] (Figure 1). This situation produces permanent connections of fibrous tissue between two previously unrelated surfaces [59,62], giving rise to adverse complications of varying severity [56]. Different types of adhesions have been observed, leading to different classifications [63][64][65][66][67].…”

Trametinib prevents mesothelial-mesenchymal transition and ameliorates abdominal adhesion formation

“…Although modern advances in surgical technique, including laparoscopy, have led to a decrease in their incidence, intestinal adhesions still pose a very significant medical as well as economic problem. 3,4 Unfortunately, adequate therapeutic solutions have proven elusive. While there are some studies using therapeutics to attempt to prevent adhesion formation, these have largely not gained wide acceptance.…”

The gap in surgical footprints : the role of connexin43 during post-surgical peritoneal adhesion formation

“…Over the years, clinical applications of several physical barriers have been approved (Moris et al, 2017). In general, the application of physical barriers (solid and liquid)…”