Page 13 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Introduction 1
Postoperative adhesion formation as a result from open and laparoscopic abdominal surgery has a high impact on patients’ quality of life and on general healthcare worldwide (1-3). The most severe complication is represented by small bowel obstruction, which is caused by adhesions in 60-70% of all cases (4-7). Additionally adhesions are responsible for 20-40% of all female patients with secondary infertility. Furthermore, during relaparoscopy or relaparotomy various problems with adhesions can be encountered; adhesiolysis may result in a prolonged operation time, more conversions and increased intra-operative complications consequently resulting in higher morbidity and mortality. Moreover trocar placement was the most common cause of inadvertent enterotomy in a collective review of laparoscopy induced bowel injury. In 68.9% of instances of bowel injury, adhesions or previous laparotomy were noted (2, 8). Another complication associated with postoperative adhesions is chronic abdominal pain, although in literature this relation remains widely under debate (9-11). Ultimately, adhesion formation often complicates mesh reinforcement during laparoscopic ventral hernia repair, possibly resulting in fistula formation, small bowel obstruction or adhesiolysis related complications as mentioned above.
Since von Dembowski described the induction of adhesion formation following abdominal surgery for the first time in 1889, many experiments and clinical studies have been performed with the intention to understand the pathophysiology, complications and options for treatment and prevention of postoperative adhesions (12). However, despite more than 120 years of experience, results of different study groups are still presented in different ways and formats complicating comparison and interpretation of all data (13-15).
At present the causes and consequences of abdominal adhesions are much better comprehended whereas the best method for treatment and especially prevention still has to be found (Chapter 2).
Introduction and outline
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