Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions

Postsurgical intra-abdominal adhesions pose a significant medical problem i n the Western world, and in the past decade progress has been made in under standing their pathophysiology. The early balance between fibrin formation and degradation in the peritoneal cavity during and after surgery seems to be a major determinant of adhesion formation. Postsurgical inhibition of fi brinolytic activity severely impairs fibrin breakdown. Adhesive small-bowel obstruction, inadvertent enterotomy at reoperation, prolonged operative ti me dividing adhesions, increased clinical workload and high financial costs are important adhesion-related problems discussed in this review. The cumu lative risk of adhesive small-bowel obstruction after (sub)total colectomy is 11% within 1 year, increasing to 30% at 10 years. One of five patients u ndergoing reoperation suffers from inadvertent enterotomy, resulting in sig nificant postoperative morbidity and mortality. Roughly 3% of all surgical admissions are associated with intra-abdominal adhesions. Clinical prospect ive trials have recently been designed to investigate the efficacy of barri er membranes and gels in the reduction of abdominal and pelvic adhesions an d prevention of long-term morbidity, e.g., adhesive bowel obstruction and i nfertility in women. Early results are promising and contribute to the incr eased interest among clinicians in postsurgical adhesion formation and its consequences.