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Peritoneale Adhäsionsbildung

Peritoneal adhesion formation

  • Chirurgie und Forschung
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Zusammenfassung

Die Ausbildung postoperativer peritonealer Adhäsionen ist eine häufige Folge abdominalchirurgischer Eingriffe. Daraus können akute und chronische Beschwerden entstehen, die häufig nur durch eine chirurgische Adhäsiolyse behoben werden können. Dies birgt jedoch das Risiko einer erneuten Adhäsionsbildung. Trotz enormer Fortschritte in der perioperativen Medizin stehen nach wie vor nur eingeschränkte Möglichkeiten der Adhäsionsprophylaxe zur Verfügung. Die atraumatische Chirurgie nimmt dabei immer noch den höchsten Stellenwert ein.

Die aktuelle Forschung beschäftigt sich mit zwei Konzepten zur Adhäsionsprophylaxe: dem Einsatz von Barrieren zur Vermeidung des Aneinanderlagerns verletzter Oberflächen in der Bauchhöhle sowie neuen immunmodulatorischen Konzepten. Trotz vielversprechender experimenteller Daten ist die klinische Studienlage zu den Barrierekonzepten sehr heterogen. Die Daten zur Entzündungsmodulation und zugleich Beeinflussung der fibrinolytischen Kapazität sind vielversprechender, meist jedoch noch experimenteller Natur.

In dem vorliegenden Artikel soll ein kurzer Überblick über die aktuellen Forschungsergebnisse zur Pathophysiologie und Adhäsionsprophylaxe gegeben werden. Die Daten zeigen die Notwendigkeit der Durchführung solider klinischer Studien und sollen zu deren Durchführung ermutigen.

Abstract

Postoperative peritoneal adhesions are common sequelae of abdominal surgery. Acute as well as chronic complications, including bowel obstruction, abdominal pain and infertility can arise from adhesion formation. So far, the only reliable treatment is surgical adhesiolysis, which in turn is accompanied by an increased risk of adhesion recurrence. Despite significant progress in modern perioperative medicine, only limited prophylactic approaches are available and atraumatic surgery is still the most important factor.

Current research concepts focus on two major antiadhesion strategies: firstly, the intraoperative placement of mechanical barriers and secondly novel immunomodulation concepts. Clinical data about the use of antiadhesive barriers show a heterogeneous outcome. Promising data have arisen from the immunomodulatory approaches and now require a step-up development from experimental to clinical trial level.

The present review gives a short overview about the current research on the pathophysiology and prevention of peritoneal adhesions. The promising data are encouraging and require realization of carefully designed prospective clinical trials.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Hong, T.O. Vilz, J.C. Kalff und S. Wehner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland

    G. Hong, T.O. Vilz, J.C. Kalff &  S. Wehner

  2. Tytgat Institute, Academisch Medisch Centrum, Amsterdam, Niederlande

    S. Wehner

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  1. G. Hong
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  2. T.O. Vilz
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  3. J.C. Kalff
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  4. S. Wehner
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Correspondence to S. Wehner.

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Hong, G., Vilz, T., Kalff, J. et al. Peritoneale Adhäsionsbildung. Chirurg 86, 175–180 (2015). https://doi.org/10.1007/s00104-014-2975-8

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  • DOI: https://doi.org/10.1007/s00104-014-2975-8

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