Page 32 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 2
Adhesion prevention: physical barriers
The concept of material-based preventive strategies is founded on physical anti-adhesive separation of denuded serosal areas from the surrounding tissue. This separation can be achieved with solid (films and gels) or fluid products. The ideal barrier should have several important characteristics as described by Brochhausen et al [38, 87]:
1. Efficient tissue separation during the period of wound healing has to be guaranteed.
2. The barrier should effectively and reliably cover the entire damaged peritoneum.
3. The material has to be biocompatible, resulting in minimal inflammation and foreign body reaction and it should stay in place without sutures or staples.
4. Easy handling, especially in minimally invasive surgery, should be given.
5. The material should be degradable and absorbable in order to avoid the need for a second operation in order to remove the barrier.
6. The degradation products of the material should not be toxic to regenerative mesenchymal cells or mesothelial cells.
7. The barrier should not impair anastomotic healing
8. The barrier should not promote infection
Barrier solutions and gels
Fluids constitute an ideal barrier agent because their action is not limited to the site of application. Their function is provided by hydroflotation of intraperitoneal structures in the liquid that is infused into the peritoneal cavity at the end of the surgical procedure. Hydroflotation provides a temporary separation between raw peritoneal surfaces allowing independent healing without the formation of adhesions. Possibly, fluid circulation in the peritoneal cavity contributes to the prevention of adhesion formation by diluting fibrinous exudates released from traumatized surfaces. Fluid barriers may prevent adhesion formation both at the traumatized area and elsewhere in the pelvis [88]. The instillation of fluids in the peritoneal cavity may be associated with some undesirable
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