Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions

Abstract

Postsurgical adhesions are a common complication of surgical procedures that can lead to postoperative pain, bowel obstruction, infertility, as well as complications with future procedures. Several agents have been developed to prevent adhesion formation, such as barriers, anti‐inflammatory and fibrinolytic agents. The Food and Drug Administration (FDA) has approved the use of physical barrier agents, but they have been associated with conflicting clinical studies and controversy in the clinical utilization of anti‐adhesion barriers. In this review, we summarize the human anatomy of the peritoneum, the pathophysiology of adhesion formation, the current prevention agents, as well as the current research progress on adhesion prevention. The early cellular events starting with injured mesothelial cells and incorporating macrophage response have recently been found to be associated with adhesion formation. This may provide the key component for developing future adhesion prevention methods. The current use of physical barriers to separate tissues, such as Seprafilm®, composed of hyaluronic acid and carboxymethylcellulose, can only reduce the risk of adhesion formation at the end stage. Other anti‐inflammatory or fibrinolytic agents for preventing adhesions have only been studied within the context of current research models, which is limited by the lack of in‐vitro model systems as well as in‐depth study of in‐vivo models to evaluate the efficiency of anti‐adhesion agents. In addition, we explore emerging therapies, such as gene therapy and stem cell‐based approaches, that may offer new strategies for preventing adhesion formation. In conclusion, anti‐adhesion agents represent a promising approach for reducing the burden of adhesion‐related complications in surgical patients. Further research is needed to optimize their use and develop new therapies for this challenging clinical problem.

Bioinspired Microstructured Janus Bioadhesive for the Prevention of Abdominal and Intrauterine Adhesions

“…Excessive oxidative stress in the wound microenvironment can cause the occurrence and development of tissue adhesions. [60] The antioxidant activity of the Janus bioadhesives was evaluated by assessing the scavenging efficiency of 2,2-Diphenyl-1picrylhydrazyl (DPPH). The characteristic absorption peaks of DPPH constantly decreased with the increasing amount of the Janus bioadhesives (Figure 3E).…”

Hemoadhican-Based Bioabsorbable Hydrogel for Preventing Postoperative Adhesions

“…Promising biomaterials used as barriers to prevent postoperative adhesions should have several advantages, including excellent biocompatibility, ease of preparation, and topical application . During the initial days following surgery, fibronectin and fibroblasts play a crucial role in the development of tissue adhesions. , Therefore, barrier materials intended for use in the peritoneal cavity should possess specific biological characteristics that resist protein and cell adhesion, while also maintaining an appropriate degradation time. , Physical barriers in the form of hydrogels are increasingly attracting attention due to their longer retention time compared to solutions and their superior ability to fully cover wound areas compared to film materials. , …”

Effectiveness of Immunostimulation for Postoperative Intra-Abdominary Adhesion in an Experimental Rat Model

“…It also greatly increases the risk of iatrogenic injury to the bowel, bladder, or other organs. Adhesions around the internal genital organs are the cause of decreased fertility in 3 out of 10 women with acquired infertility [7][8][9][10][11][12][13].…”