Do intra-abdominal adhesions cause pain?

Abstract

Hard to prove

Comparative study of peritoneal adhesions after intraperitoneal implantation in rats of meshes of polypropylene versus polypropylene/polyglecaprone versus polyester/porcine collagen

“…The infection of the operated site determines a prolonged inflammatory response and directly compromises the fibroplasia phase and collagen deposition, favoring the appearance of more intense adhesions, chronic infection of the mesh, retraction of the prosthesis, and appearance of meshoma 28 . In a clinical scenario, this outcome represents an important risk factor for complications such as visceral adhesions, chronic pain, intestinal obstruction, fistulization, hernia recurrence, and reoperations 14-15 . Therefore, the presence of complications related to the operative wound, such as dehiscence, favors the contamination and infection of the prosthesis, which represents an important risk factor for the failure of the synthetic mesh implant in the treatment of abdominal wall defects 29 .…”

“…Although the use of meshes for the repair of abdominal wall hernia defects is widely accepted and widespread, and has a positive impact in reducing failure rates and relapses 6 , the intra-abdominal use of most available prostheses is restricted. After implantation intraperitoneally, they can determine important adhesions between the surface of the mesh and the intra-abdominal viscera, especially with the small intestine, the colon and the epiploon, favoring the appearance of chronic abdominal pain, intestinal obstruction, enterocutaneous fistulas, chronic infection of the mesh, and a consequent need for surgeries to treat such complications, or even complicating conventional or laparotomic and videolaparotomic approaches after hernioplasty, leading to a significant morbidity and additional costs 13-15 .…”

Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions

“…Based on our current understanding, postsurgical adhesions are caused by the combination of wound healing and a series of cascades that includes, but is not limited to, hypoxia, coagulation, inflammation, and fibrin degradation 60 . The cellular mechanism of these cascades is mainly dependent on the fibrinolytic system involving mesothelial cells 8,18,60 . Neither the degree and details of each event, nor the whole cascade related to adhesion formation have been studied systematically.…”

“…Postsurgical adhesion can occur throughout the human body following various types of operations, 51 such as cardiac, 52 peritoneum, 1,2,8 epidural, 53 as well as tendon procedures. 54 However, the pathophysiology of the different kinds of adhesion formation is still unclear as the tissue compositions are different between human cavities.…”

“…[5][6][7] Common complications associated with postsurgical adhesions include small bowel obstruction, chronic pelvic pain, dyspareunia, infertility, and a higher risk of adhesion formation in subsequent surgical operations. 1,[8][9][10][11] Despite improvements in surgical technique, such as the development of minimally invasive surgery, which reduces tissue trauma and external contamination; adhesions still occur in up to 45%-64% of abdominal operations. 1,2,9,12 It has been postulated that postsurgical adhesions are triggered by tissue trauma or injury, and other contributory factors during the procedure, such as sharp, mechanical, or thermal irritation; ischemia; abrasion; and exposure to foreign bodies such as fiber, powder, irritating fluids, and airflow causing oxidative stress.…”