Anatomy - Adhesiolysis, open - general and visceral surgery

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  • Pathophysiology

    Intraabdominal adhesions are a protective mechanism to limit pathological processes in inflammatory abdominal diseases as well as postoperatively. These adhesions arise from an imbalance between fibrin production and fibrinolysis. Since 93% of patients develop postoperative adhesions in the abdomen or pelvic region, causing intestinal obstruction in up to 74% of cases, prevention of postoperative adhesions is a major surgical challenge. Adhesion prophylaxis is based on three key concepts:

    1. Avoidance mesothelial injuries (e.g., gentle surgical techniques, avoidance of dehydration, prolonged thermocautery, mass ligatures, repeated intestinal clamping, and grasping the serosa with sharp instruments)

    2. Least foreign body materials possible (e.g., glove powder, dry towels, intestinal contents)

    3. Suppression of inflammatory reactions.

    Since between 11% and 21% of surgical cases with intestinal obstruction as sequela of intestinal adhesions will suffer from recurrent adhesions, in turn leading to obstruction, predisposition for adhesions must be presumed in some patients Among the potential factors implicated are: pathological plasminogen activator activity, increased fibronectin synthesis rate and dysregulation of cytokinin production.

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