Postoperative intrabdominal adhesions

Pados G1,2, Almaloglou K2, Bontis J1

1First Department of Obstetrics and Gynecology, Aristotele University of Thessaloniki, Papageorgiou general hospital, Thessaloniki, Greece
2Center for Endoscopic Surgery, Iatriko Diavalkaniko hospital, Thessaloniki, Greece

Correspondence: Pados George, Mitropoleos 40 St, GR-54623 Thessaloniki, Greece


Postoperative adhesions are a significant complication of all abdominal surgical procedures. Adhesions formation is a consequence of peritoneal trauma and may lead to infertility, bowel obstruction and chronic pelvic pain. The major strategies for adhesion prevention are focused to the optimization of surgical technique and the use of antiadhesive agents which fall into two main categories, drugs and barriers. Surgical technique that minimize peritoneal trauma can reduce, but cannot prevent postoperative adhesion formation. Various local and systemic drugs that can alter the local inflammatory response, inhibit the coagulation cascade and promote fibrinolysis, have been evaluated, but none has been found effective for postoperative adhesions reduction. Barriers are currently the most useful adjuncts, which may reduce adhesion formation. They act by separating the traumatized peritoneal surfaces during the healing period. The separation can be achieved by solid barriers (films or gel) or by fluids. Solid barriers have the limitations that they are site-specific and difficult to be used in laparoscopic surgery.

Keywords: laparoscopy, anti-adhesion barrier agents, adhesions

p. 309-326