title: Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature.
abstract: BACKGROUND
  Post-operative adhesions after gastrointestinal surgery are responsible for significant morbidity and constitute an important public health problem. The aim of this study was to review the surgical literature to determine the incidence, consequences and the variety of possible countermeasures to prevent adhesion formation.
  
  
  METHODS
  A systematic review of English and French language surgical literature published between 1995 and 2009 was performed using the keywords "adhesion" and "surgery".
  
  
  RESULTS
  Peritoneal adhesions are reported as the cause of 32% of acute intestinal obstruction and 65-75% of all small bowel obstructions. It is estimated that peritoneal adhesions develop after 93-100% of upper abdominal laparotomies and after 67-93% of lower abdominal laparotomies. Nevertheless, only 15-18% of these adhesions require surgical re-intervention. The need for re-intervention for adhesion-related complications varies depending on the initial type of surgery, the postoperative course and the type of incision. The laparoscopic approach appears to decrease the risk of adhesion formation by 45% and the need for adhesion-related re-intervention to 0.8% after appendectomy and to 2.5% after colorectal surgery. At the present time, only one product consisting of hyaluronic acid applied to a layer of carboxymethylcellulose (Seprafilm(®)) has been shown to significantly reduce the incidence of postoperative adhesion formation; but this product is also associated with a significant increase in the incidence of anastomotic leakage when the membrane is applied in direct contact with the anastomosis. The use of this product has not been shown to decrease the risk of re-intervention for bowel obstruction.
  
  
  CONCLUSIONS
  The prevention of postoperative adhesions is an important public health goal, particularly in light of the frequency of this complication. The routine use of anti-adhesion products is not recommended given the lack of studies with a high level of evidence concerning their efficacy and safety of use.
authors.affiliation: Service de chirurgie digestive et viscérale, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. Mehdi.ouaissi@mail.ap-hm.fr
authors.forename: M
authors.initials: M
authors.lastname: Ouaïssi
authors.forename: S
authors.initials: S
authors.lastname: Gaujoux
authors.forename: N
authors.initials: N
authors.lastname: Veyrie
authors.forename: E
authors.initials: E
authors.lastname: Denève
authors.forename: C
authors.initials: C
authors.lastname: Brigand
authors.forename: B
authors.initials: B
authors.lastname: Castel
authors.forename: J J
authors.initials: JJ
authors.lastname: Duron
authors.forename: A
authors.initials: A
authors.lastname: Rault
authors.forename: K
authors.initials: K
authors.lastname: Slim
authors.forename: D
authors.initials: D
authors.lastname: Nocca
mesh_terms: D013505:Digestive System Surgical Procedures; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy; D008567:Membranes, Artificial; D010532:Peritoneal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery
chemical_list: D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid