Adhesion Prevention Strategies in Laparoscopic Surgery

Abstract

Adhesions are defined as abnormal attachments between tissues and organs [ ]. Intra-abdominal adhesions may be classified as congenital or acquired [ ]. Congenital adhesions are a consequence of embryological anomaly in the development of the peritoneal cavity. Acquired adhesions result from the inflammatory response of the peritoneum that arises after intra-abdominal inflammatory processes e.g. acute appendicitis, pelvic inflammatory disease, exposure to intestinal contents and previous use of intrauterine contraceptive devices , radiation and surgical trauma [ ]. It has been reported that the majority of acquired adhesions about % are post-surgical [ ].Factors associated with the formation of post-surgical adhesions include tissue trauma, infection, ischaemia,reaction to foreign bodies sutures, powder from gloves, gauze particles etc. , haemorrhage, tissue overheating or desiccation and exposure to irrigation fluids [ ]. The incidence of intra-abdominal adhesions ranges from % to % after general surgical abdominal operations and from % to % after gynecological procedures. Not unexpectedly, adhesion formation is considered one of the most common post-operative complications [ , ]. Post-surgically, many adhesions may be asymptomatic or can lead to a broad spectrum of clinical problems, including intestinal obstruction, chronic pelvic or abdominal pain and female infertility, requiring re-admission and often additional surgery, while at the same time they can complicate future surgical procedures [ ]. Adhesion-related re-operations are a common consequence of gynecological procedures and adhesiolysis is followed by a high incidence of adhesion reformation and de-novo adhesion formation [ ].The major strategies for adhesion prevention in gynecological surgery aim at the optimization of surgical technique and use of adhesion-prevention agents. Laparoscopic surgery in gynecology represents the most innovative surgical approach, compared with laparotomy since it has been shown from a large number of clinical, but also experimental studies, that is associated with less development of de novo adhesions. Without any doubt, the most important factor is the operating surgeon, whose attention to proper surgical technique will serve as a mainstay for adhesion formation.

Genipin-crosslinked gelatin microspheres as a strategy to prevent postsurgical peritoneal adhesions: In vitro and in vivo characterization

“…The microspheres mass that remains, results in the organization and formation of adhesions [1], [2] .…”

“…But at sites of surgical or inflammatory injury, levels of PAI are increased, which inhibit fibrinolytic activity. Additionally, deficient blood supply and reduced tissue oxygenation, typically for surgical injury, decrease fibrinolysis resulting in adhesion development [1], [2].…”

“…At day 14, when peritoneal healing is completed, adhesions will remain [1], [2] . GP-MS-treated mice did not develop peritoneal adhesions and the peritoneal layer covering abdominal wall and viscera had a normal appearance by day 14.…”

“…Efficacy of Hyalobarrier ® was investigated in a rat uterine horn model [65], [66] . Subsequently, cytokines IL-1ß, IL-6 and TNF-, inflammatory markers released during the peritoneal adhesions cascade [1], [2] , were analysed in plasma and peritoneal fluid. None of the cytokines were present in plasma above the limit of detection (55.2 pg/ml for IL-1ß, 58.8 pg/ml for IL 6, 30.5 pg/ml for TNF-) at any time point (day 1, 7 and 14 post-operative).…”

Response: adhesion barrier market trends

“…Adhesion formation is considered one of the most common post-operative complications, occurring in 60% to 90% of patients after gynecological procedures (Pados et al, 2012). Thus, the major strategies for adhesion prevention in gynecological surgery aim at the optimization of the surgical approach and the use of adhesion-prevention agents, the latter being subdivided into pharmacological agents and intraperitoneal barriers (solid or liquid).…”