title: The Onset of Intra-Abdominal Adhesions During Closed-Abdomen Hyperthermic Intraperitoneal Chemotherapy.
abstract: BACKGROUND
  Hyperthermic intraperitoneal chemotherapy (HIPEC) is delivered after cytoreductive surgery (CRS) in selected patients with peritoneal carcinomatosis. The closed-abdomen technique, preferred by many centers, prevents heat loss and drug spillage, but does not warrant homogeneous distribution of the perfusion fluid (PF). The hypothesized formation of intra-abdominal adhesions during the closed-abdomen perfusion period has never been described.
  
  
  METHODS
  From March 2014 to April 2016, 10 consecutive patients with peritoneal carcinomatosis, selected for CRS, underwent the Laparoscopy-Enhanced HIPEC technique to explore the abdominal cavity during the perfusion. The aim of the study was to investigate the incidence and the extent of intra-abdominal adhesions that are formed after CRS during the perfusion period of closed-abdomen HIPEC.
  
  
  RESULTS
  During the perfusion, adhesions developed in 70% of the patients. Adhesions developed mainly in the period between the closure of the abdomen and the subsequent filling of the abdomen with the PF. After their first division, during the following perfusion period, adhesions between the bowel and the abdominal wall reformed in 3 patients (30%).
  
  
  CONCLUSIONS
  Intra-abdominal adhesions are frequently formed during closed-abdomen HIPEC and can hamper the adequate circulation of the PF. The Laparoscopy-Enhanced technique enables the early detection and the division of any intra-abdominal adhesions.
authors.affiliation: 1 Advanced Surgical Oncology Unit, Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Lotti
authors.affiliation: 2 Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Michela
authors.initials: M
authors.lastname: Giulii Capponi
authors.affiliation: 2 Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Campanati
authors.affiliation: 2 Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Elia
authors.initials: E
authors.lastname: Poiasina
authors.affiliation: 2 Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: 2 Department of General Surgery 1, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Eugenio
authors.initials: E
authors.lastname: Poletti
authors.affiliation: 3 Department of Gynecology and Obstetrics, Papa Giovanni XXIII Hospital , Bergamo, Italy .
authors.forename: Luigi
authors.initials: L
authors.lastname: Frigerio
mesh_terms: D034841:Abdominal Cavity; D034861:Abdominal Wall; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D013274:Stomach Neoplasms / Q000473:pathology*; D013997:Time Factors; D000267:Tissue Adhesions / Q000453:epidemiology*
chemical_list: D000970:Antineoplastic Agents
keywords: HIPEC; cytoreductive surgery; intraperitoneal chemotherapy; laparoscopic HIPEC; laparoscopy enhanced HIPEC; peritoneal carcinomatosis