Prevention of postoperative peritoneal adhesions: a review of the literature.
BACKGROUND
postoperative adhesions are a significant health problem with major implications on quality of life and health care expenses. The purpose of this review was to investigate the efficacy of preventative techniques and adhesion barriers and identify those patients who are most likely to benefit from these strategies.


METHODS
the National Library of Medicine, Medline, Embase, and Cochrane databases were used to identify articles related to postoperative adhesions.


RESULTS
ileal pouch-anal anastomosis, open colectomy, and open gynecologic procedures are associated with the highest risk of adhesive small-bowel obstruction (class I evidence). Based on expert opinion (class III evidence) intraoperative preventative principles, such as meticulous hemostasis, avoiding excessive tissue dissection and ischemia, and reducing remaining surgical material have been published. Laparoscopic techniques, with the exception of appendicitis, result in fewer adhesions than open techniques (class I evidence). Available bioabsorbable barriers, such as hyaluronic acid/carboxymethylcellulose and icodextrin 4% solution, have been shown to reduce adhesions (class I evidence).


CONCLUSIONS
postoperative adhesions are a significant health problem with major implications on quality of life and health care. General intraoperative preventative techniques, laparoscopic techniques, and the use of bioabsorbable mechanical barriers in the appropriate cases reduce the incidence and severity of peritoneal adhesions.
Schnüriger
Beat
B
Los Angeles County Medical Center, University of Southern California, Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery and Surgical Critical Care, LAC + USC Medical Center, Room 1105, 1200 North State St, Los Angeles, CA, USA.
Barmparas
Galinos
G
Branco
Bernardino C
BC
Lustenberger
Thomas
T
Inaba
Kenji
K
Demetriades
Demetrios
D
D006801:Humans; D010532:Peritoneal Diseases / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D000267:Tissue Adhesions / Q000503:physiopathology / Q000517:prevention & control