This editorial opinion article is based on our own experience and literature review. The NESA adhesion formation study team members recommend an unique model as a hypothesis building and testing tool in a surgical experimental research.
Body textPostsurgical adhesions are believed to be the result of surgical tissue trauma in presence of multi factorial etiology of excessive healing, which may interfere with the physiological mechanisms at any stage [1]. The key points of postsurgical adhesions includes firstly the fixation of the intra-peritoneal structures to the parietal and/or visceral peritoneum, keeping them attached longer than in physiological wound healing [2] and secondly the initiation of excessive healing, caused by inflammation [3], which in turn may be triggered by surgical factors [4].Postsurgical adhesions have evoked hard-to-cure and high-costly problems for the healthcare systems overall with such frequent complications such as small bowel obstructions with negative effects on patients' health, and increased workloads in clinical practice [5].High-costs were associated with postsurgical adhesion complications as demonstrated in an analysis of annual inpatient care and expenditures based on a national hospital discharge data which were used to identify all abdominal adhesion related procedures performed in the United States in 1994 [6]: validated data with a ten-year followup of 12,584 patients undergoing lower abdominal surgery from the Scottish National Health Service Medical Record Linkage Database in UK [7] and in a study aimed to examine the natural course of patients following surgery for small bowel obstruction with a 14 year-follow-up in Sweden [8]. Under the evidence-based assumption that the risk of adhesions in colorectal surgery called for the necessity of opportunities and strategies for improvement the team of distinguished surgeons 'called for action' in their paper [9] to colorectal surgeons "to make prevention of adhesions more of a priority and importantly to inform patients of the risks associated with adhesion-related complications during the consent process".From this view long lasting attempts of researchers and surgeons to find an optimal adhesion preventing adjuvant have legitimated their expectations and the expenses were well worth it. Unfortunately until now most of suggested adhesion preventive adjuvant have shown their efficiency only in experimental models and failed in clinical trials.Previously we demonstrated key steps of surgical research, namely the selection of the research questions, hypothesis building to set goals as well as the elaboration of a study design and interpretation of results based on our experimental studies and a systematic review of literature [10]. In our experimental researches we aimed to study an impact of surgical trauma and CO 2 -insufflation on adhesion formation [3,10] to demonstrate the developing of research questions, the building of a hypothesis, and the setting of goals and the elaboration of a study design as well as the...