Etiology, pathogenesis and prophylaxis of adhesions in abdominal surgery

Abstract

The review presents the data on the etiology and pathogenesis of intra-abdominal adhesions after abdominal surgical interventions. It has been shown that the main etiological preconditions for formation of adhesions and the development of adhesive intestinal obstruction are a peritoneal injury, intraabdominal bleeding, presence of infection and foreign bodies in the abdominal cavity, influence of various aggressive substances, local antibiotic therapy, and regional tissue ischemia. This leads to an increase in the amount of peritoneal fluid, the penetration of microorganisms into the abdominal cavity with disturbance of the metabolism of the peritoneum mesothelium and damage to the cellular membranes, tissue organization of fibrinous matrix, degranulation of lysosomal enzymes, the pituitary-adrenal insufficiency, and the development of hypercoagulation and postoperative paresis of the intestine. The situation is aggravated by the addition of an autoimmune or allergic component to the inflammatory process. The main modern methods of adhesion prevention are described, taking into account the latest achievements in abdominal surgery, including the use of D-penicillamine, the drugs blocking the activity of collagen synthesis enzymes, anticoagulants of various actions, gels Polymers, proteolytic enzymes, antioxidants, hemostatics, hyperbaric oxygenation, as well as insufflation of carbon dioxide into the abdominal cavity. A special place is given to the use of synthetic absorbable suture materials, dynamic laparoscopy and laparoscopic adhesion.