title: Introduction: Quality of pelvic surgery and postoperative adhesions.
abstract: The health care and the emotional cost of postoperative adhesions that frequently cause chronic pain, infertility, bowel obstruction, and repeat surgery are well known. Our understanding of the pathophysiology of adhesion formation and of its prevention has evolved from good surgical practice based on microsurgical principles, barriers to keep denuded areas separated to the prevention of mesothelial cell damage and of acute inflammation in the entire peritoneal cavity. Oxidative stress, in the surgical lesions and in the peritoneal cavity has an important role in adhesion formation by slowing down repair. This has resulted in virtually adhesion-free surgery, in addition with less CO2resorption, less postoperative pain, and a faster recovery. The clinical efficacy had been demonstrated by higher pregnancy rates (PRs) using microsurgical tenets.
authors: Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Leuven, Belgium. Electronic address: pkoninckx@gmail.com.
authors: Philippe R
authors: PR
authors: Koninckx
authors: Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia, Canada.
authors: Victor
authors: V
authors: Gomel
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000592:standards*; D006801:Humans; D018384:Oxidative Stress; D010149:Postoperative Pain / Q000209:etiology; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D020127:Recovery of Function; D012307:Risk Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Surgery quality; microsurgery; oxidative stress; postoperative adhesion formation