Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options.
BACKGROUND
Intra-abdominal adhesions arise after more than 50% of all abdominal operations and are an important source of postoperative complications. They attach normally separated organs to each other and can cause major problems for the affected patients by giving rise to small bowel obstruction, chronic pelvic pain, dyspareunia, infertility, and higher complication rates in subsequent operations. They are also a frequent source of medicolegal conflict. Thus, every physician should be familiar with their mechanism of origin, their consequences, and the methods by which they can be prevented.


METHODS
A selective PubMed/Medline search from 1960 onward as well as articles to which these publications referred. The expert consensus position of the European Society for Gynaecological Surgery is also taken into consideration.


RESULTS
Adhesions arise through aberrant wound healing after peritoneal injury with further influence from a variety of other factors. Preventive measures include minimizing peritoneal injury intraoperatively through the meticulous observance of basic surgical principles, moistening the mesothelium to keep it from drying out, irrigating the peritoneal cavity to remove blood and clot, and keeping the use of intra-abdominal foreign material to a minimum.


CONCLUSIONS
Adhesions are an inevitable consequence of intra-abdominal surgery. They can be prevented to some extent with meticulous surgical technique and certain other measures. For operations carrying a high risk of postoperative adhesions, e.g., surgery on the adnexa or bowel, commercially available peritoneal instillates or barrier methods can be used to limit adhesion formation.
CARE Group (Clinical Adhesion Research and Evaluation Group), Klinik für Gynäkologie und Geburtshilfe, Justus-Liebig-Universität Gießen, Germany.
Dörthe
D
Brüggmann
Garri
G
Tchartchian
Markus
M
Wallwiener
Karsten
K
Münstedt
Hans-Rudolf
HR
Tinneberg
Andreas
A
Hackethal
D000005:Abdomen / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D018570:Risk Assessment; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000517:prevention & control*