Adhesions.
Although several decades have passed since the first theories concerning normal healing and adhesion formation processes were proposed, the possible role of some factors is still under investigation. The availability of recombinant murine interleukin-1 allowed the assumption that interleukin-1 may be an important short-term mediator of adhesion formation. The definite effect of prostaglandin E2 on adhesion formation was also further elucidated, whereas prostaglandin F2 alpha was found to play a minimal role in the inflammatory process, which is the initial step in the pathogenesis of adhesions. The development of recombinant tissue plasminogen activator offers a unique alternative to augment the depressed endogenous fibrinolytic system. Intraperitoneal application of recombinant tissue plasminogen activator to injured animal models showed significant reduction in both de novo and reformation of adhesions. The presumption that operative laparoscopy is more beneficial than laparotomy with regard to postoperative adhesion development is demonstrated by the latest studies on this topic. Recently developed barrier methods, including natural or synthetic materials, have been tested in animal models and appear promising in reducing both formation and reformation of adhesions. Until these are introduced in clinical practice, the immediate future will certainly involve the further expansion of absorbable barriers.
Pados
G A
GA
Centre for Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University, Belgium.
Devroey
P
P
D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D007813:Laparotomy / Q000009:adverse effects; D010532:Peritoneal Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications; D000267:Tissue Adhesions / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control