The formation of intra-abdominal adhesions represents a protective mechanism for containing a pathological process, both in inflammatory abdominal diseases and postoperatively. The cause of intra-abdominal adhesion formation is a shift in the balance between fibrin formation and fibrinolysis. Since adhesions form in 93% of patients after surgery in the abdomen or pelvic area and these cause up to 74% of cases of intestinal obstructions, the prevention of postoperative adhesions represents a central surgical problem. Adhesion prophylaxis is based here on three major pillars:
1. Avoidance of mesothelial injuries (e.g. gentle
operating, avoidance of drying out, extensive thermal hemostasis, mass ligations, repeated clamping of the intestine, grasping the serosa with sharp instruments)
2. Reduction of foreign body material (e.g. glove powder,
dry cloths, intestinal contents)
3. Inhibition of the inflammatory reaction.
Since after surgical treatment of adhesions that had caused an intestinal obstruction, in 11 to 21% of cases, another obstruction occurred due to renewed formation of adhesions, an individual predisposition to adhesions must also be suspected. Under discussion here are: pathological plasminogen activator activity, increased fibronectin synthesis rate, and dysregulation of cytokine production.
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Pathophysiology