Page 76 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 4
Table 2. Adhesions scores
Adhesions Treated Control P score (n = 15) (%) (n = 16) (%) value
000
1 3 (20)
2 9 (60)
3 3 (20)
Discussion
1 (6,3)
13 (81,3)
2 (12,5) 0,39
Adhesions are fibrous bands that form between two damaged peritoneal surfaces that normally are separated. In 1973, Raftery showed that injury of the serosal layer of the peritoneum leads to an inflammatory exudate followed by fibrin deposition, which is the beginning of adhesion formation22. The precise underlying mechanism is complex: the clotting pathway, extracellular matrix proteins, and various cytokines and growth factors are involved23-25, with eventually production of a fibrin matrix with fibroblasts and collagen that creates the adhesions. Fibrinolytic activity resolves this fibrin matrix26,27 and is necessary for a balance between the formation and breaking down of fibrous depositions. However, fybrinolysis is reduced by inflammation and infection, and thus the balance is disturbed after surgery, particularly when surgery is followed by an infectious complication.
Adhesions are a frequent problem after abdominal surgery, with an incidence as high as 95%, resulting in important and invalidating complications such as bowel obstruction, female infertility, and chronic pain1,2,6-8,10. In addition to their undesirable clinical impact, adhesions are associated with substantial increases in health costs, as has been shown by large trials on adhesion-related readmissions conducted by Ellis et al. and Parker et al.3,4. Therefore, adhesion prevention would be a highly valuable extension of surgical interventions, as surgical trauma is one of the most important triggers in the formation of adhesions.
Several ways of adhesion prevention have been studied, the majority involving intra-abdominally applied adhesion barriers with the goal of
74