Page 24 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences
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                                Chapter 2
to inflammatory processes, in order to regenerate the damaged part. The balance between fibrinogenesis and fibrinolysis seems to be a key factor in the formation of adhesions, however knowledge regarding the different steps in the cascade is still insufficient due to its complexity [4]. Further understanding of the pathophysiology may help to develop strategies in order to prevent adhesion formation.
    Macrophages
Mediators of inflammation
Ingrowth of fibroblasts nerves, vessels organized adhesions
Peritoneal wound
Coagulation phase
 v
Platelet activvation
Damage to bvlood vessels
 Mesotvhelium
 v
   Thrombin
v
exudation
Fibrinogen
v
exudation
v
Peritoneal fluid
  Granulocytve activation
v
Inflammation
 Formation of fibrin matrix
 Fibrinolysis phase
  PAI-1, PAI-2 fibrin residues
t-PA, u-PA fibrin cleavage products
  Complete healing within 72 h
                  Figure 1. Overview of pathophysiological inter-relationships and factors thought to be involved in the origin of adhesions. Modified from Holmdahl et al[13], [12]
Impact of postoperative abdominal adhesions
For many years the incidence and clinical impact of post-surgical adhesion formation remained underestimated. Apart from one post- mortem study, before 1990 the incidence of post-operative abdominal adhesions was not investigated [18]. That year the first clinical study was published, demonstrating an incidence of 93% in patients who underwent one or more previous abdominal operations [21]. This result was confirmed by two studies of Luijendijk et al, who found postoperative
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