Page 23 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
Interestingly, after minor as well as severe trauma re-epithelisation
is completed in 5-8 days [7]. Within 72h after injury mesothelial cells originating from perivascular connective tissue will form islands of cells throughout the wound base [7, 15]. Consequently re-epithelisation does 2 not only take place from the wound edges but also from the center,
enabling the peritoneum to heal in the same amount of time after small as well as larger injury. Hence the formation of postoperative abdominal adhesions will always take place within 5-8 days from the initial trauma.
The above-described pathogenesis of adhesion formation is the unifying concept, which emerges when reassessing more than 50 years of experimental and clinical work. However, more recently it was postulated that individual differences in peritoneal inflammatory status, procoagulant activity and fibrin dissolving capacity determine whether fibrin deposits persist – and thereby lead to permanent adhesions – or not. The authors suggested that there is special need for more prospective studies examining the extent of adhesion formation in relation to the inflammatory state and factors of coagulation and fibrinolysis in the individual patient [16].
Although adhesions may be distributed among the whole peritoneal cavity the preferential localizations are to the greater omentum, the abdominal wall scar and to the small bowel [17, 18]. They can be described using a classification proposed by Diamond et al. [19, 20]: Type 1 are de novo adhesions which are adhesions occurring at sites with no previous adhesion, subdivided into adhesions at sites where no surgical procedure was performed (caused by indirect trauma or inflammation, type 1a, and adhesions at sites of a surgical procedure other than adhesiolysis (caused by direct trauma, type 1b).
Type 2 are called reformed adhesions which are adhesions reforming at sites of previous adhesiolysis, occurring at sites of adhesiolysis only or occurring at sites of adhesiolysis, plus sites of another procedure.
To summarize, the formation of abdominal adhesions is a dynamic and complex process influenced by many parameters. A cascade of responses follows injury to the peritoneum, whether by surgery or due
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