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1 - Intraperitoneal adhesions: pathogenesis, clinical significance, and prevention strategies
Akın Fırat Kocaay, Süleyman Utku Çelik, Tevfik Eker, Ömer Arda Çetinkaya, Volkan Genç
Postoperative peritoneal adhesion is an important clinical challenge in gastrointestinal, colorectal, and gynecologic surgery. Adhesions are the most frequent cause of long-term complications, including chronic abdominal pain, female infertility, mechanical small bowel obstruction, and injury at reoperations. Postoperative adhesion formation is a natural consequence of peritoneal irritation by surgical tissue trauma or infection, and may be considered as the pathological part of healing following any peritoneal injury. In the search for effective methods for preventing postoperative adhesions, several clinical techniques and agents have been investigated. Strategies for reduction of adhesions are based on their natural pathophysiological mechanisms of origin, including activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Despite initial promising results of different measures in postoperative adhesions prevention, none of them have become a standard application and achieved mostly in animal model. Until additional information and findings from future clinical investigations, only a meticulous surgical technique can be recommended to reduce morbidity and mortality rates from these undesirable and troublesome effects of surgery. In the current state of knowledge, further pre-clinical and clinical investigations are necessary to evaluate the prevention strategies of postoperative peritoneal adhesions.
Keywords: Adhesions, fibrin, intestinal obstruction, peritoneum
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