Postoperative abdominal adhesion: pathophysiology and prevention (review)

Magomedov Mukhuma Magomedovich, Imanaliev Magomed Rasulovich, Magomedov Magomed Arsenevich

Peritoneal adhesions are an important clinical problem in gastrointestinal surgery. Peritoneal adhesions are the result of irritation of the peritoneum by infection or surgical trauma and can be considered as a pathological part of healing after any injury to the peritoneum, in particular due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity, leading to multiple complications, many of which may occur several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions can cause pelvic or abdominal pain and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis, and various preventive strategies for adhesion formation. Several prophylactic agents have been investigated against postoperative peritoneal adhesions. Their role is aimed at activating fibrinolysis, making it difficult for blood to clot, reducing the inflammatory response, inhibiting collagen synthesis, or creating a barrier between adjacent wound surfaces. Their results are promising, but most of them are controversial and are achieved mainly in the animal model. Until further results from future clinical trials are obtained, only careful surgery can be recommended to reduce unnecessary morbidity and mortality from these adverse effects of surgery. With the current state of knowledge, preclinical or clinical studies are still needed to evaluate the effectiveness of developing strategies for the prevention of postoperative peritoneal adhesions is discussed in this review.

Keywords:abdominal surgery, laparoscopy, complication, adhesiolysis, abdominal pain, adhesions.