Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan.
BACKGROUND
Intra-abdominal adhesions and abscesses cause significant morbidity and mortality. The formation of fibrin in the abdominal cavity is a common pathophysiological pathway for both. The aim of this review was to investigate the pathophysiology of intra-abdominal adhesions and abscesses, and to explore the possible sites of action of hyaluronan.


METHODS
Data were reviewed from the literature using the Medline database.


RESULTS
Both surgery and peritonitis disturb the equilibrium between coagulation and fibrinolysis in the abdominal cavity in favour of the coagulation system. Hyaluronan-based agents reduce adhesion formation after surgery. Moreover, hyaluronan solution reduces abscess formation in experimental peritonitis. Possible mechanisms of action include mechanical separation of wound surfaces, improvement of peritoneal healing, modulation of the inflammatory response and enhanced fibrinolysis.


CONCLUSIONS
Diminished fibrin degradation is a common pathway for the formation of adhesions and abscesses. The potential of hyaluronan-based agents to reduce intra-abdominal adhesions and abscesses in abdominal surgery and sepsis is a promising new concept. Elucidating the mechanisms involved and the clinical application of hyaluronan in peritonitis are challenges for future research.
Department of Surgery, University Medical Centre St Radboud, Nijmegen, The Netherlands. mmpj.reijnen@worldonline.nl
M M P J
MM
Reijnen
R P
RP
Bleichrodt
H
H
van Goor
D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid