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World J Gastroenterol. Nov 7, 2011; 17(41): 4545-4553
Published online Nov 7, 2011. doi: 10.3748/wjg.v17.i41.4545
Pathophysiology and prevention of postoperative peritoneal adhesions
Willy Arung, Michel Meurisse, Olivier Detry
Willy Arung, Department of General Surgery, Cliniques Universitaires de Lubumbashi, University of Lubumbashi, Lubumbashi 1825, Katanga Province, Congo
Michel Meurisse, Olivier Detry, Department of Abdominal Surgery and Transplantation, CHU de Liège, University of Liege, Liège B4000, Belgium
Author contributions: Arung W performed the review and wrote the manuscript; Meurisse M and Detry O supervised the review and corrected the manuscript.
Correspondence to: Olivier Detry, Professor, Department of Abdominal Surgery and Transplantation, CHU de Liège, University of Liege, Liège B4000, Belgium. oli.detry@chu.ulg.ac.be
Telephone: +32-4-3667645 Fax: +32-4-3664069
Received: May 4, 2011
Revised: August 26, 2011
Accepted: September 3, 2011
Published online: November 7, 2011

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly 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 resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

Keywords: Abdominal surgery, Laparoscopy, Complication, Occlusion, Abdominal pain