Adhesive small bowel obstruction: epidemiology, biology and prevention

Abstract

Intraabdominal adhesions develop after abdominal surgery as part of the normal healing processes that occur after damage to the peritoneum. Over the last 2 decades, much research has gone into understanding the biochemical and cellular processes that lead to adhesion formation. The early balance between fibrin deposition and degradation seems to be the critical factor in adhesion formation. Although adhesions do have some beneficial effects, they also cause significant morbidity, including adhesive small bowel obstruction, infertility and increased difficulty with reoperative surgery. Several strategies have been employed over the years to prevent adhesion formation while not interfering with wound healing. This article summarizes much of our current understanding of adhesion formation and strategies that have been employed to prevent them.

FIG. 1. Biological events involved in peritoneal tissue repair and adhesion formation. PAI-1 = plasminogen activator inhibitors group 1; tPA = tissue plasminogen activator; uPA= urokinase-like plasminogen activator.