Page 15 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Abdominal surgery for intra-abdominal infection with peritonitis is 1 associated with high morbidity and mortality rates and complicated frequently by abscess formation. In peritonitis, severe inflammation of
the peritoneum occurs, increasing adhesion formation.
Chapter 5 describes the results of an experiment with the same barrier as described in Chapters 3 and 4, but now tested on safety and efficacy in the contaminated environment.
In laparoscopic incisional hernia repair, direct contact between the prosthesis and the abdominal viscera is inevitable, which may lead to an inflammatory reaction resulting in abdominal adhesion formation. Currently, a wide variety of synthetic and biologic hernia reinforcement materials is available on the market, complicating the selection of an appropriate prosthesis.
In Chapter 6 the outcome of an experiment in which different synthetic and biological meshes were tested on their anti-adhesive properties is presented, aiming to help in the selection of an appropriate prosthesis.
Perforation (15-25%) and abscess formation (0-5%) are both complications of acute appendicitis that lead to localized or generalized peritonitis and subsequently induce abdominal adhesion formation. These adhesions have been considered to be associated with chronic abdominal pain.
In Chapter 7 a study with long-term follow-up of seven years with the aim to investigate whether complicated appendicitis would result in more abdominal complaints than uncomplicated acute appendicitis is set out.
In Chapter 8 the results of a study with an analogous design to the study as described in Chapter 7 are presented, however now patients operated for diverticular disease are included. The primary outcome of the study is the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis.
In Chapter 9 the results of the studies performed in this thesis are summarized and discussed.
In Chapter 10 suggestions for further research concerning postoperative abdominal adhesions are given.
Introduction and outline
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