Peritoneal repair and post-surgical adhesion formation

Abstract

It was shown in 1919 that peritoneal healing differs from that of skin. When a defect is made in the parietal peritoneum the entire surface becomes epithelialized simultaneously and not gradually from the borders as in epidermalization of skin wounds. While multiplication and migration of mesothelial cells from the margin of the wound may play a small part in the regenerative process, it cannot play a major role, since new mesothelium develops in the centre of a large wound at the same time as it develops in the centre of a smaller one. Development of intraperitoneal adhesions is a dynamic process whereby surgically traumatized tissues in apposition bind through fibrin bridges which become organized by wound repair cells, often supporting a rich vascular supply as well as neuronal elements.

Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy

“…In the injured area, a gel matrix of fibrin will form and macrophages recruit new mesothelial cells over the damaged surface which reaches the reconstruction of the mesothelial lining within 5-7 days. The adhesions will take place if the surfaces damaged remain in contact [23,24]. This finding supports the idea of an ovariopexy.…”

A neurokinin 1 receptor antagonist decreases postoperative peritoneal adhesion formation and increases peritoneal fibrinolytic activity

“…Studies in humans and in animal models have shown that surgical trauma initiates an inflammatory reaction that leads to deposition of a fibrin-rich matrix on peritoneal surfaces that is capable of forming attachments to adjacent viscera (11,12). If the matrix organizes into fibroblast-containing fibrin bands, permanent adhesions can form as early as 7 days after abdominal operations (13).…”

Effects of saline lavage temperature on peritoneal fibrinolysis and adhesion formation

“…[7] The two main differences are epithelization and consequences of fibrin deposition. Firstly, peritoneal epithelization takes place throughout the entire surface of the defect simultaneously.…”