There is lack of information among patients and physicians about adhesions and their complications. Written information before surgery and computer-based applications may help raise patient's awareness.

The formation of peritoneal adhesions is an issue for surgical research. Different adhesion-inducing models with subsequent scoring systems are descriptively published. The lack of uniformity is a problem as the reproducibility of experimental adhesion research depends strongly on the employed scoring system. A uniform, widely-used score that seeks to describe this relevant surgical condition would be beneficial for inter-surgeon comparability. We present and contrast six scoring systems after the traumatisation of the parietal peritoneum in the rat model. Advantages, disadvantages and statistical considerations of these systems are highlighted. Experimental adhesions were created bilaterally in n=11 Wistar rats. This resulted in n=22 adhesion areas. Standardised trauma was inflicted to the parietal peritoneum in a linear shape (20×5 mm) using bipolar electrocautery at 40 W. The defect was closed using five interrupted 3/0 Vicryl sutures placed equidistantly. After 14 days, second look laparotomy was performed and number of adhesions, adhesion coverage, adhesion strength, adhesion quality and the attachment to target organs were scored. A total of 43 adhesions formed at the traumatised areas. All of these adhesions could be scored using the six systems described. The correlation coefficient for adhesion coverage as assessed by a measuring stick versus digital computer analysis of the area was 0.649. Every single scoring approach describes different characteristics of adhesions with non-uniform clinical relevance. A multi-dimensional approach that takes account of statistical considerations is inevitable rather than just the use of limited scoring approaches in the experimental setting.

These experiments provide proof of principle that intra-operative local injection of pharmaceutical agents is a promising strategy for adhesion prophylaxis. Once sutiable agents become available this could become as common as local anesthesia for pain reduction. However, the effect of injected prednisolone diminishes before the vulnerable time-frame for adhesion formation closes. Therefore slow-release formulations and other agents with longer effect will need to be investigated in the future.