Page 153 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Summary and general discussion
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, 2]. 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 [3].
At present the causes and consequences are much better comprehended whereas the best method for treatment and especially prevention still has to be found. The number of papers concerning the subject of postoperative adhesion formation runs to thousands and multiple books have been written [4]. Consequently, it is almost impossible to address every aspect of this complex and wide-ranging subject.
In Chapter 2 a selection of the current views on different aspects of postoperative abdominal adhesion formation has been given.
Adhesion prevention
In recent years, many studies have been performed in an attempt to
find an effective adhesion prevention method following abdominal operations. These methods include pharmacological agents, site-
specific physical barriers and broad-coverage physical barriers. All
barriers have in common that a temporary chemical interface prevents 9 adhesions to develop between the parietal peritoneal defect and the
visceral peritoneum. Unfortunately, despite all efforts, no product has been adopted for general clinical use in abdominal surgery [5, 6].
In Chapter 3 the effect of a new physical barrier on adhesion formation in a rat model was investigated. This barrier is a hydrogel consisting of physically cross-linked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC). PVA is the anti-adhesion component while CMC promotes attachment at the wound side and the gel can be applied at the end of the operation on the viscera. The results showed that the new PVA/CMC gel appears to be a safe and effective adhesion
Summary and discussion
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