Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions

Abstract

Postsurgical intra-abdominal adhesions pose a significant medical problem in the Western world, and in the past decade progress has been made in understanding their pathophysiology. The early balance between fibrin formation and degradation in the peritoneal cavity during and after surgery seems to be a major determinant of adhesion formation. Postsurgical inhibition of fibrinolytic activity severely impairs fibrin breakdown. Adhesive small-bowel obstruction, inadvertent enterotomy at reoperation, prolonged operative time dividing adhesions, increased clinical workload and high financial costs are important adhesion-related problems discussed in this review. The cumulative risk of adhesive small-bowel obstruction after (sub)total colectomy is 11% within 1 year, increasing to 30% at 10 years. One of five patients undergoing reoperation suffers from inadvertent enterotomy, resulting in significant postoperative morbidity and mortality. Roughly 3% of all surgical admissions are associated with intra-abdominal adhesions. Clinical prospective trials have recently been designed to investigate the efficacy of barrier membranes and gels in the reduction of abdominal and pelvic adhesions and prevention of long-term morbidity, e.g., adhesive bowel obstruction and infertility in women. Early results are promising and contribute to the increased interest among clinicians in postsurgical adhesion formation and its consequences.