Page 27 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
in those cases that diligent electrocautery cannot provide adequate hemostasis, fine non-reactive sutures should be used [40].
Closure of the peritoneum should be avoided according to experimental 2 evidence [41, 42]. Grafting or suturing peritoneal defects may increase peritoneal ischemia, devascularisation and necrosis, predisposing the
site to decreased fibrinolytic activity and increased adhesion formation
[43]. This finding is supporting the opinion that outcome improves with nonclosure of the peritoneum [38, 41, 44]. Nevertheless, peritoneal closure after caesarian section is still controversially discussed in literature [45]. Different studies were not able to show that non-closure is better than closure, or vice versa [46]. Additionally a systematic review concluded that some evidence suggest that non-closure of the peritoneum after caesarean section is associated with more adhesion formation compared to closure [47]. Carefully planned prospective studies should be attempted in order to investigate which technique should be preferred after caesarean section.
Exposure to foreign materials such as glove powder, lint from packs, sutures and material extruded from the digestive tract induces a peritoneal inflammatory response and is consequently associated with an increased risk of extensive postoperative peritoneal adhesions. The use of powder-free gloves and biocompatible suture material is therefore strongly recommended [11, 17]. Furthermore, when gauzes are used in the abdominal cavity they should routinely drenched in saline to prevent adhesion formation. Nonetheless, controversy exists over the benefits of this technique. In order to prevent injury to the serosa replacement by an atraumatic bag might be advisable when bowel needs to be packed outside the operative field [48].
Laparoscopy versus laparotomy
After the introduction of laparoscopy many surgeons assumed that this technique would induce fewer adhesions than laparotomy owing to less peritoneal trauma. Therefore a large number of experiments and clinical studies has been performed showing that, in general, adhesion formation is less pronounced after laparoscopy when compared to open surgery
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