Postoperative Abdominal Adhesions: Clinical Significance and Advances in Prevention and Management

Abstract

Postoperative adhesions remain one of the more challenging issues in surgical practice. Although peritoneal adhesions occur after every abdominal operation, the density, time interval to develop symptoms, and clinical presentation are highly variable with no predictable patterns. Numerous studies have investigated the pathophysiology of postoperative adhesions both in vitro and in vivo. Factors such as type and location of adhesions, as well as timing and recurrence of adhesive obstruction remain unpredictable and poorly understood. Although the majority of postoperative adhesions are clinically silent, the consequences of adhesion formation can represent a lifelong problem including chronic abdominal pain, recurrent intestinal obstruction requiring multiple hospitalizations, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and no effective therapy. Despite recent advances in surgical techniques, there is no reliable strategy to manage postoperative adhesions. We herein review the pathophysiology and clinical significance of postoperative adhesions while highlighting current techniques of prevention and treatment.

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References

  1. 1.

    Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Digestive surgery. 2001;18(4):260–73. doi:50149.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World journal of surgery. 2010;34(12):2805–12. doi:10.1007/s00268-010-0778-8.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Wiseman DM. Disorders of adhesions or adhesion-related disorder: monolithic entities or part of something bigger--CAPPS? Seminars in reproductive medicine. 2008;26(4):356–68. doi:10.1055/s-0028-1082394.

    PubMed  Article  Google Scholar 

  4. 4.

    Bruggmann D, Tchartchian G, Wallwiener M, Munstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Deutsches Arzteblatt international. 2010;107(44):769–75. doi:10.3238/arztebl.2010.0769.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World journal of gastroenterology. 2011;17(41):4545–53. doi:10.3748/wjg.v17.i41.4545.

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC et al. Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. The British journal of surgery. 2010;97(1):70–8. doi:10.1002/bjs.6742.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    van Goor H. Consequences and complications of peritoneal adhesions. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2007;9 Suppl 2:25–34. doi:10.1111/j.1463-1318.2007.01358.x.

    Article  Google Scholar 

  8. 8.

    Rajab TK, Kimonis KO, Ali E, Offodile AC, Brady M, Bleday R. Practical implications of postoperative adhesions for preoperative consent and operative technique. Int J Surg. 2013;11(9):753–6. doi:10.1016/j.ijsu.2013.07.019.

    PubMed  Article  Google Scholar 

  9. 9.

    Herrmann A, De Wilde RL. Adhesions are the major cause of complications in operative gynecology. Best Pract Res Clin Obstet Gynaecol. 2016;35:71–83. doi:10.1016/j.bpobgyn.2015.10.010.

    PubMed  Article  Google Scholar 

  10. 10.

    Cheong YC, Laird SM, Li TC, Shelton JB, Ledger WL, Cooke ID. Peritoneal healing and adhesion formation/reformation. Human reproduction update. 2001;7(6):556–66.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Duron JJ. Postoperative intraperitoneal adhesion pathophysiology. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2007;9 Suppl 2:14–24. doi:10.1111/j.1463-1318.2007.01343.x.

    Article  Google Scholar 

  12. 12.

    Ivarsson ML, Bergstrom M, Eriksson E, Risberg B, Holmdahl L. Tissue markers as predictors of postoperative adhesions. The British journal of surgery. 1998;85(11):1549–54.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Ichinose A, Takio K, Fujikawa K. Localization of the binding site of tissue-type plasminogen activator to fibrin. The Journal of clinical investigation. 1986;78(1):163–9. doi:10.1172/JCI112546.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Norrman B, Wallen P, Ranby M. Fibrinolysis mediated by tissue plasminogen activator. Disclosure of a kinetic transition. European journal of biochemistry. 1985;149(1):193–200.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Holmdahl L, Eriksson E, Al-Jabreen M, Risberg B. Fibrinolysis in human peritoneum during operation. Surgery. 1996;119(6):701–5.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Lu HR, Wu Z, Pauwels P, Lijnen HR, Collen D. Comparative thrombolytic properties of tissue-type plasminogen activator (t-PA), single-chain urokinase-type plasminogen activator (u-PA) and K1K2Pu (a t-PA/u-PA chimera) in a combined arterial and venous thrombosis model in the dog. Journal of the American College of Cardiology. 1992;19(6):1350–9.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Vassalli JD, Pepper MS. Tumour biology. Membrane proteases in focus. Nature. 1994;370(6484):14–5. doi:10.1038/370014a0.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Andreasen PA, Georg B, Lund LR, Riccio A, Stacey SN. Plasminogen activator inhibitors: hormonally regulated serpins. Molecular and cellular endocrinology. 1990;68(1):1–19.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–80. doi:10.1016/S0140-6736(98)09337-4.

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Rout UK, Diamond MP. Role of plasminogen activators during healing after uterine serosal lesioning in the rat. Fertility and sterility. 2003;79(1):138–45.

    PubMed  Article  Google Scholar 

  21. 21.

    Holmdahl L, Ivarsson ML. The role of cytokines, coagulation, and fibrinolysis in peritoneal tissue repair. The European journal of surgery = Acta chirurgica. 1999;165(11):1012–9. doi:10.1080/110241599750007810.

    CAS  PubMed  Google Scholar 

  22. 22.

    ten Broek RP, Schreinemacher MH, Jilesen AP, Bouvy N, Bleichrodt RP, van Goor H. Enterotomy risk in abdominal wall repair: a prospective study. Ann Surg. 2012;256(2):280–7.

    PubMed  Article  Google Scholar 

  23. 23.

    ten Broek RP, Strik C, Issa Y, Bleichrodt RP, van Goor H. Adhesiolysis-related morbidity in abdominal surgery. Annals of surgery. 2013;258(1):98–106. doi:10.1097/SLA.0b013e31826f4969.

    PubMed  Article  Google Scholar 

  24. 24.

    Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87(4):467–71.

    Article  Google Scholar 

  25. 25.

    Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. The European journal of surgery Supplement : = Acta chirurgica Supplement. 1997 (577):5–9.

    Google Scholar 

  26. 26.

    Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl. 1997;577:5–9.

    Google Scholar 

  27. 27.

    Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Human reproduction. 2004;19(8):1877–85. doi:10.1093/humrep/deh321.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Diseases of the colon and rectum. 2001;44(6):822–29; discussion 9-30.

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2005;7(6):551–8. doi:10.1111/j.1463-1318.2005.00857.x.

    CAS  Article  Google Scholar 

  30. 30.

    ten Broek RP, Issa Y, van Santbrink EJ, Bouvy ND, Kruitwagen RF, Jeekel J et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. Bmj. 2013;347:f5588. doi:10.1136/bmj.f5588.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Strik C, Stommel MW, Schipper LJ, van Goor H, Ten Broek RP. Long-term impact of adhesions on bowel obstruction. Surgery. 2016;159(5):1351–9. doi:10.1016/j.surg.2015.11.016.

    PubMed  Article  Google Scholar 

  32. 32.

    ten Broek RP, Strik C, van Goor H. Preoperative nomogram to predict risk of bowel injury during adhesiolysis. The British journal of surgery. 2014;101(6):720–7. doi:10.1002/bjs.9479.

    PubMed  Article  Google Scholar 

  33. 33.

    Sisodia V, Sahu SK, Kumar S. Clinical Profile of Patients with Postoperative Adhesive Intestinal Obstruction and its Association with Intraoperative Peritoneal Adhesion Index. Chirurgia. 2016;111(3):251–8.

    PubMed  Google Scholar 

  34. 34.

    Ray NF, Larsen JW, Jr., Stillman RJ, Jacobs RJ. Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surgery, gynecology & obstetrics. 1993;176(3):271–6.

    CAS  Google Scholar 

  35. 35.

    Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. Journal of the American College of Surgeons. 1998;186(1):1–9.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Coleman MG, McLain AD, Moran BJ. Impact of previous surgery on time taken for incision and division of adhesions during laparotomy. Diseases of the colon and rectum. 2000;43(9):1297–9.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Beck DE, Ferguson MA, Opelka FG, Fleshman JW, Gervaz P, Wexner SD. Effect of previous surgery on abdominal opening time. Diseases of the colon and rectum. 2000;43(12):1749–53.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Wilson MS. Practicalities and costs of adhesions. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2007;9 Suppl 2:60–5. doi:10.1111/j.1463-1318.2007.01360.x.

    Article  Google Scholar 

  39. 39.

    Ten Broek RP, Kok-Krant N, Bakkum EA, Bleichrodt RP, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Human reproduction update. 2013;19(1):12–25. doi:10.1093/humupd/dms032.

    PubMed  Article  Google Scholar 

  40. 40.

    Burns EM, Currie A, Bottle A, Aylin P, Darzi A, Faiz O. Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery. The British journal of surgery. 2013;100(1):152–9. doi:10.1002/bjs.8964.

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Lyell DJ, Caughey AB, Hu E, Blumenfeld Y, El-Sayed YY, Daniels K. Rectus muscle and visceral peritoneum closure at cesarean delivery and intraabdominal adhesions. American journal of obstetrics and gynecology. 2012;206(6):515 e1–5. doi:10.1016/j.ajog.2012.02.033.

    Article  Google Scholar 

  42. 42.

    Liakakos T, Thomakos N, Fine PM, Dervenis C and Young RL ( 2001 ) Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 18, 260–273.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, Crowe AM; Surgical and Clinical Research (SCAR) Group. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Hum Reprod. 2004;19(8):1877–85.

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Corona R, Verguts J, Koninckx R, Mailova K, Binda MM, Koninckx PR. Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions. American journal of obstetrics and gynecology. 2011;205(4):392 e1–7. doi:10.1016/j.ajog.2011.06.091.

    Article  Google Scholar 

  45. 45.

    O'Leary DP, Coakley JB. The influence of suturing and sepsis on the development of postoperative peritoneal adhesions. Annals of the Royal College of Surgeons of England. 1992;74(2):134–7.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Elkins TE, Stovall TG, Warren J, Ling FW, Meyer NL. A histologic evaluation of peritoneal injury and repair: implications for adhesion formation. Obstetrics and gynecology. 1987;70(2):225–8.

    CAS  PubMed  Google Scholar 

  47. 47.

    Schreinemacher MH, van Barneveld KW, Peeters E, Miserez M, Gijbels MJ, Greve JW et al. Adhesions to sutures, tackers, and glue for intraperitoneal mesh fixation: an experimental study. Hernia : the journal of hernias and abdominal wall surgery. 2014;18(6):865–72. doi:10.1007/s10029-013-1192-6.

    CAS  Article  Google Scholar 

  48. 48.

    Ishikawa K, Sadahiro S, Tanaka Y, Suzuki T, Kamijo A, Tazume S. Optimal sutures for use in the abdomen: an evaluation based on the formation of adhesions and abscesses. Surgery today. 2013;43(4):412–7. doi:10.1007/s00595-012-0249-y.

    PubMed  Article  Google Scholar 

  49. 49.

    Walfisch A, Beloosesky R, Shrim A, Hallak M. Adhesion prevention after cesarean delivery: evidence, and lack of it. American journal of obstetrics and gynecology. 2014;211(5):446–52. doi:10.1016/j.ajog.2014.05.027.

    PubMed  Article  Google Scholar 

  50. 50.

    Blumenthal-Barby JS, Kostick KM, Delgado ED, Volk RJ, Kaplan HM, Wilhelms LA et al. Assessment of patients’ and caregivers’ informational and decisional needs for left ventricular assist device placement: Implications for informed consent and shared decision-making. Journal of Heart and Lung Transplantation. 2015;34(9):1182–9. doi:10.1016/j.healun.2015.03.026.

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Deeken CR, Faucher KM, Matthews BD. A review of the composition, characteristics, and effectiveness of barrier mesh prostheses utilized for laparoscopic ventral hernia repair. Surgical endoscopy. 2012;26(2):566–75. doi:10.1007/s00464-011-1899-3.

    PubMed  Article  Google Scholar 

  52. 52.

    Gonzalez R, Rodeheaver GT, Moody DL, Foresman PA, Ramshaw BJ. Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia : the journal of hernias and abdominal wall surgery. 2004;8(3):213–9. doi:10.1007/s10029-004-0213-x.

    CAS  Article  Google Scholar 

  53. 53.

    Smolarek S, Shalaby M, Paolo Angelucci G, Missori G, Capuano I, Franceschilli L et al. Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2016;20(4):e2016.00073. doi:10.4293/JSLS.2016.00073.

    PubMed  PubMed Central  Article  Google Scholar 

  54. 54.

    Takase-Sanchez MM, Brooks HM, Hale DS, Heit MH. Obliterative Surgery for the Treatment of Pelvic Organ Prolapse: A Patient Survey on Reasons for Surgery Selection and Postoperative Decision Regret and Satisfaction. Female Pelvic Medicine and Reconstructive Surgery. 2015;21(6):325–31. doi:10.1097/spv.0000000000000198.

    PubMed  Article  Google Scholar 

  55. 55.

    Sidana A, Hernandez DJ, Feng Z, Partin AW, Trock BJ, Saha S et al. Treatment decision-making for localized prostate cancer: what younger men choose and why. Prostate. 2012;72(1):58–64. doi:10.1002/pros.21406.

    PubMed  Article  Google Scholar 

  56. 56.

    Kavic SM, Kavic SM. Adhesions and adhesiolysis: the role of laparoscopy. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2002;6(2):99–109.

    PubMed  PubMed Central  Google Scholar 

  57. 57.

    Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Human reproduction (Oxford, England). 2004;19(8):1877–85. doi:10.1093/humrep/deh321.

    CAS  Article  Google Scholar 

  58. 58.

    Scholin J, Buunen M, Hop W, Bonjer J, Anderberg B, Cuesta M et al. Bowel obstruction after laparoscopic and open colon resection for cancer: results of 5 years of follow-up in a randomized trial. Surgical endoscopy. 2011;25(12):3755–60. doi:10.1007/s00464-011-1782-2.

    PubMed  Article  Google Scholar 

  59. 59.

    Pados G, Venetis CA, Almaloglou K, Tarlatzis BC. Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence. Reproductive biomedicine online. 2010;21(3):290–303. doi:10.1016/j.rbmo.2010.04.021.

    CAS  PubMed  Article  Google Scholar 

  60. 60.

    Mais V. Peritoneal adhesions after laparoscopic gastrointestinal surgery. World Journal of Gastroenterology : WJG. 2014;20(17):4917–25. doi:10.3748/wjg.v20.i17.4917.

    PubMed  PubMed Central  Article  Google Scholar 

  61. 61.

    Loeb S, Meyer CP, Krasnova A, Curnyn C, Reznor G, Kibel AS et al. Risk of Small Bowel Obstruction After Robot-Assisted vs Open Radical Prostatectomy. Journal of endourology. 2016;30(12):1291–5. doi:10.1089/end.2016.0206.

    PubMed  Article  Google Scholar 

  62. 62.

    Lundorff P, Hahlin M, Källfelt B, Thorburn J, Lindblom B. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Fertil Steril. 1991;55(5):911–5.

    CAS  PubMed  Article  Google Scholar 

  63. 63.

    Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7(6):567–76.

    CAS  PubMed  Article  Google Scholar 

  64. 64.

    Risberg B. Adhesions: preventive strategies. The European journal of surgery Supplement : = Acta chirurgica Supplement. 1997(577):32–9.

    Google Scholar 

  65. 65.

    diZerega GS. Use of adhesion prevention barriers in pelvic reconstructive and gynecologic surgery. In: diZerega, editor. Peritoneal Surgery. New York: Springer; 2000. p. 379–99.

  66. 66.

    ten Broek RP, Stommel MW, Strik C, van Laarhoven CJ, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet (London, England). 2014;383(9911):48–59. doi:10.1016/s0140-6736(13)61687-6.

    Article  Google Scholar 

  67. 67.

    Ahmad G, O'Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. The Cochrane database of systematic reviews. 2015(4):CD000475. doi:10.1002/14651858.CD000475.pub3.

    Google Scholar 

  68. 68.

    Zeng Q, Yu Z, You J, Zhang Q. Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World journal of surgery. 2007;31(11):2125–31; discussion 32. doi:10.1007/s00268-007-9242-9.

    PubMed  Article  Google Scholar 

  69. 69.

    Al-Jabri S, Tulandi T. Management and prevention of pelvic adhesions. Seminars in reproductive medicine. 2011;29(2):130–7. doi:10.1055/s-0031-1272475.

    PubMed  Article  Google Scholar 

  70. 70.

    Wiseman DM, Trout JR, Franklin RR, Diamond MP. Metaanalysis of the safety and efficacy of an adhesion barrier (Interceed TC7) in laparotomy. The Journal of reproductive medicine. 1999;44(4):325–31.

    CAS  PubMed  Google Scholar 

  71. 71.

    Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Diseases of the colon and rectum. 2006;49(1):1–11. doi:10.1007/s10350-005-0268-5.

    PubMed  Article  Google Scholar 

  72. 72.

    Robb WB, Mariette C. Strategies in the prevention of the formation of postoperative adhesions in digestive surgery: a systematic review of the literature. Dis Colon Rectum. 2014;57(10):1228–40. doi:10.1097/DCR.0000000000000191.

    PubMed  Article  Google Scholar 

  73. 73.

    Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG et al. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Diseases of the colon and rectum. 2003;46(10):1310–9. doi:10.1097/01.DCR.0000089117.62296.E4.

    PubMed  Article  Google Scholar 

  74. 74.

    van der Wal JB, Iordens GI, Vrijland WW, van Veen RN, Lange J, Jeekel J. Adhesion prevention during laparotomy: long-term follow-up of a randomized clinical trial. Annals of surgery. 2011;253(6):1118–21. doi:10.1097/SLA.0b013e318217e99c.

    PubMed  Article  Google Scholar 

  75. 75.

    Chen TA, Yeh CY. Long-term Follow-up of Adhesion Prevention With Use of Hyaluronic Acid-carboxymethylcellulose Membrane (Seprafilm). Annals of surgery. 2017;265(4):e27. doi:10.1097/sla.0000000000000421.

    PubMed  Article  Google Scholar 

  76. 76.

    Kiefer DG, Muscat JC, Santorelli J, Chavez MR, Ananth CV, Smulian JC et al. Effectiveness and short-term safety of modified sodium hyaluronic acid-carboxymethylcellulose at cesarean delivery: a randomized trial. American journal of obstetrics and gynecology. 2016;214(3):373 e1- e12. doi:10.1016/j.ajog.2015.10.012.

    Article  Google Scholar 

  77. 77.

    Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. Journal of the American College of Surgeons. 1996;183(4):297–306.

    CAS  PubMed  Google Scholar 

  78. 78.

    Dasiran F, Eryilmaz R, Isik A, Okan I, Somay A, Sahin M. The effect of polyethylene glycol adhesion barrier (Spray Gel) on preventing peritoneal adhesions. Bratislavske lekarske listy. 2015;116(6):379–82.

    CAS  PubMed  Google Scholar 

  79. 79.

    Bothin C, Midtvedt T. The role of the gastrointestinal microflora in postsurgical adhesion formation—a study in germfree rats. European surgical research Europaische chirurgische Forschung Recherches chirurgicales europeennes. 1992;24(5):309–12.

    CAS  PubMed  Article  Google Scholar 

  80. 80.

    Bothin C, Okada M, Midtvedt T, Perbeck L. The intestinal flora influences adhesion formation around surgical anastomoses. The British journal of surgery. 2001;88(1):143–5. doi:10.1046/j.1365-2168.2001.01613.x.

    CAS  PubMed  Article  Google Scholar 

  81. 81.

    Moris D, Felekouras E, Chrousos GP. No Cytokine Is an Island: IL-6 Alone Is not Sufficient to Predict Morbidity after a Major Abdominal Surgery. Annals of surgery. 2016. doi:10.1097/SLA.0000000000001977.

  82. 82.

    Cahill RA, Wang JH, Redmond HP. Enteric bacteria and their antigens may stimulate postoperative peritoneal adhesion formation. Surgery. 2007;141(3):403–10. doi:10.1016/j.surg.2006.09.010.

    PubMed  Article  Google Scholar 

  83. 83.

    Oncel M, Kurt N, Remzi FH, Sensu SS, Vural S, Gezen CF et al. The effectiveness of systemic antibiotics in preventing postoperative, intraabdominal adhesions in an animal model. The Journal of surgical research. 2001;101(1):52–5. doi:10.1006/jsre.2001.6245.

    CAS  PubMed  Article  Google Scholar 

  84. 84.

    Bothin C, Midtvedt T, Perbeck L. Orally delivered antibiotics which lower bacterial numbers decrease experimental intra-abdominal adhesions. Langenbeck's archives of surgery. 2003;388(2):112–5. doi:10.1007/s00423-003-0369-3.

    CAS  PubMed  Google Scholar 

  85. 85.

    Drago L, Toscano M, De Grandi R, Casini V, Pace F. Persisting changes of intestinal microbiota after bowel lavage and colonoscopy. European journal of gastroenterology & hepatology. 2016;28(5):532–7. doi:10.1097/MEG.0000000000000581.

    Article  Google Scholar 

  86. 86.

    Fry DE. Antimicrobial Bowel Preparation for Elective Colon Surgery. Surgical infections. 2016;17(3):269–74. doi:10.1089/sur.2015.271.

    PubMed  Article  Google Scholar 

  87. 87.

    Rodgers KE, Girgis W, Campeau JD, di Zerega GS. Reduction of adhesion formation by intraperitoneal administration of anti-inflammatory peptide 2. Journal of investigative surgery : the official journal of the Academy of Surgical Research. 1997;10(1–2):31–6.

    CAS  Article  Google Scholar 

  88. 88.

    Guvenal T, Cetin A, Ozdemir H, Yanar O, Kaya T. Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Human Reproduction. 2001;16(8):1732–5.

    CAS  PubMed  Article  Google Scholar 

  89. 89.

    Kirdak T, Uysal E, Korun N. Assessment of effectiveness of different doses of methylprednisolone on intraabdominal adhesion prevention. Ulusal travma ve acil cerrahi dergisi= Turkish journal of trauma & emergency surgery: TJTES. 2008;14(3):188–91.

    Google Scholar 

  90. 90.

    Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World journal of gastroenterology. 2011;17(41):4545–53.

    PubMed  PubMed Central  Article  Google Scholar 

  91. 91.

    Hong GS, Schwandt T, Stein K, Schneiker B, Kummer MP, Heneka MT et al. Effects of macrophage-dependent peroxisome proliferator-activated receptor γ signalling on adhesion formation after abdominal surgery in an experimental model. Br J Surg. 2015;102(12):1506–16. doi:10.1002/bjs.9907.

    CAS  PubMed  Article  Google Scholar 

  92. 92.

    Javaherzadeh M, Shekarchizadeh A, Kafaei M, Mirafshrieh A, Mosaffa N, Sabet B. Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat. Bull Emerg Trauma. 2016;4(3):156–60.

    PubMed  PubMed Central  Google Scholar 

  93. 93.

    Brochhausen C, Schmitt VH, Rajab TK, Planck CN, Krämer B, Tapprich C et al. Mesothelial morphology and organisation after peritoneal treatment with solid and liquid adhesion barriers—a scanning electron microscopical study. J Mater Sci Mater Med. 2012;23(8):1931–9. doi:10.1007/s10856-012-4659-6.

    CAS  PubMed  Article  Google Scholar 

  94. 94.

    Chaturvedi AA, Lomme RM, Hendriks T, van Goor H. Prevention of postsurgical adhesions using an ultrapure alginate-based gel. The British journal of surgery. 2013;100(7):904–10. doi:10.1002/bjs.9131.

    CAS  PubMed  Article  Google Scholar 

  95. 95.

    Fredriksson F, Sellberg F, Bowden T, Engstrand T, Berglund D, Lilja HE. Sutures impregnated with carbazate-activated polyvinyl alcohol reduce intraperitoneal adhesions. J Pediatr Surg. 2017. doi:10.1016/j.jpedsurg.2017.01.058.

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Correspondence to Timothy M. Pawlik.

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Moris, D., Chakedis, J., Rahnemai-Azar, A.A. et al. Postoperative Abdominal Adhesions: Clinical Significance and Advances in Prevention and Management. J Gastrointest Surg 21, 1713–1722 (2017). https://doi.org/10.1007/s11605-017-3488-9

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Keywords

  • Peritoneal
  • Adhesions
  • Review
  • Complications