[Prevention of postoperative adhesions].
Postoperative adhesions represent a common consequence in patients who underwent abdominal or pelvic surgery. Such adhesions can be asymptomatic, but they can cause complications such as chronic abdomino-pelvic pain, secondary infertility, an increase in bowel obstruction risk and more complexity for future surgery, including longer surgery times and an increase in morbidity. Normally, adhesions appear after offences against the peritoneum, causing flogosys, and develop both in new sites, previously not involved, and in sites already interested in adhesiolysis. Previous laparotomy is an important risk factor, as after laparatomy a minimum of 93% of patients present adhesions during a following surgery. Furthermore, the rate of recurrence after adhesiolysis is 85%. Among several strategies employed, valid prevention methods are: using minimally invasive surgery techniques, reducing the incision area, containing tissue dehydration during surgery and an accurate hemostasis. Also, for preventing and reducing adhesions, the usage of NSAIDs, fibrinolytics and anticoagulants, as well as the application of substances acting as a physical barrier, have been proposed. Recently, crystalloid solutions have been introduced, using the hydro-flotation principle for intraperitoneal organs. This research aims to analyze causes and epidemiology for postoperative adhesions, with particular regard to gynecological operations and to describe and compare the means available to prevent them.
Palaia
I
I
Dipartimento di Ostetricia e Ginecologia, Università di Roma La Sapienza, Roma, Italia.
Boni
T
T
Angioli
R
R
Muzii
L
L
Polidori
N F
NF
Andrei
N F
NF
Musella
A
A
De Oronzo
M A
MA
Guzzo
F
F
Benedetti Panici
P
P
D015746:Abdominal Pain / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D050866:Liquid Crystals; D017699:Pelvic Pain / Q000209:etiology; D012307:Risk Factors; D055502:Secondary Prevention; D000267:Tissue Adhesions / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D005343:Fibrinolytic Agents