Abdominal and pelvic adhesions are a major cause of morbidity. Appendicitis and appendicectomy are the commonest cause of intra-abdominal adhesion formation. Peritoneal injury, from a variety of causes, leads to peritoneal inflammation and with it the production of plasminogen activator inhibitors. These inhibitors result in the loss of normal mesothelial fibrinolytic activity, and if prolonged, this allows the organisation of fibrinous adhesions into permanent fibrous adhesions. Adhesions may be prevented by minimising injury and there is increasing evidence that laparoscopic surgery is an important method of adhesion prevention. A wide variety of products have been used experimentally to prevent adhesion formation but clinical interest at present is focused on the use of bioresorbable membranes which allow localised adhesion prevention. These products have been proven effective by randomised clinical trials and their use as a routine method of preventing intra-abdominal adhesion formation is likely to increase.

Keywords:
Adhesion, Peritoneum, Plasminogen activator, Plasminogen activator inhibitors, Mesothelium
1.
Thompson JN, Whawell SA: The pathogenesis and prevention of adhesion formation. Br J Surg 1995;82:3–5.
2.
Menzies D, Ellis H: Intestinal obstruction from adhesions: How big is the probelm? Ann R Coll Surg Engl 1990;72:60–63.
3.
Bevan PG: Adhesive obstruction. Ann R Coll Surg Engl 1984;66:164–169.
4.
Raf LE: Causes of abdominal adhesions in cases of intestinal obstruction. Acta Chir Scand 1969;135:73–76.
5.
McEntee G, Pender D, Mulvin D, et al: Current spectrum of intestinal obstruction. Br J Surg 1987;74:976–980.
6.
Tanphiphat C, Chittmittrapap S, Prasopsunti K: Adhesive small bowel obstruction: A review of 321 cases in a Thai hospital. Am J Surg 1987;154:283–287.
7.
Füzun M, Kaymak E, Harmancioglu O, Astarcioglu K: Principal causes of mechanical bowel obstruction in surgically treated adults in western Turkey. Br J Surg 1991;78:202–203.
8.
Scott-Coombes DM, Vipond MN, Thompson JN: Surgeons attitudes to the treatment and prevention of abdominal adhesions. Ann R Coll Surg Engl 1993;75:123–128.
9.
Ray NF, Larsen JW, Stillman RJ, Jacobs J: Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surg Gynecol Obstet 1993;176:271–276.
10.
Johnson FR, Whiting HW: Repair of parietal peritoneum. Br J Surg 1962;49:653–660.
11.
Raftery AT: Regeneration of parietal and visceral peritoneum: An electron microscopical study. J Anat 1973;115:375–392.
12.
Myrhe-Jensen O, Larsen SB, Astrup T: Fibrinolytic activity in serosal and synovial membranes. Arch Pathol 1969;88:623–630.
13.
Porter JM, Ball AP, Silver D: Mesothelial fibrinolysis. J Thorac Cardiol Vasc Surg 1971;62:725–730.
14.
Buckman RF, Buckman D, Hufnagel HB, Gervin AS: A physiological basis for the adhesion-free healing of the peritonealised surfaces. J Surg Res 1976;21:67–76.
15.
Thompson JN, Patterson-Brown S, Harbourne T, Whawell SA, Kalodiki E, Dudley HAF: Reduced human peritoneal plasminogen activating activity: As possible mechanism of adhesion formation. Br J Surg 1989;76:382–384.
16.
Vipond MN, Whawell SA, Thompson JN, Dudley HAF: Peritoneal fibrinolytic activity and intra-abdominal adhesions. Lancet 1990;i:1120–1122.
17.
Holmdahl L, Eriksson E, Al-Jabreen M, Risberg B: Fibrinolysis in Human Peritoneum during Surgery; thesis, University of Goteborg, 1994.
18.
Scott-Coombes DM, Whawell SA, Vipond MN, Thompson JN: The human intraperitoneal fibrinolytic response to elective surgery. Br J Surg 1995;82:414–417.
19.
Whawell SA, Vipond MN, Scott-Coombes DM, Thompson JN: Plasminogen activator inhibitor-2 inhibits peritoneal fibrinolytic activity in inflammation. Br J Surg 1993;80:107–109.
20.
Whawell SA, Wang Y, Fleming KA, Thompson EM, Thompson JN: Localisation of plasminogen activator inhibitor-1 production in inflamed appendix by in situ mRNA hybridisation. J Pathol 1993;169:67–71.
21.
Whawell SA, Thompson EM, Fleming KA, Thompson JN: Plasminogen activator inhibitor-2 expression in inflamed appendix. Histophathology 1995;27:75–78.
22.
Vipond MN, Whawell SA, Thompson JN, Dudley HAF: Effect of experimental peritonitis and ischaemia on peritoneal fibrinolytic activity. Eur J Surg 1994;160:471–477.
23.
Badia JM, Scott-Coombes DM, Whawell SA, Abel PD, Williamson RCN: Peritoneal and systemic cytokine response to laparotomy. Br J Surg 1996;83:347–348.
24.
Van Hinsbergh VWM, Kooistra T, Schaffer MA, Van Bockel JM, Van Muijen GMP: Characterisation and fibrinolytic properties of human omental tissue mesothelial cells. Comparison with endothelial cells. Blood 1990;75:1490–1497.
25.
Whawell SA, Scott-Coombes DM, Vipond MN, Tebbutt SJ, Thompson JN: Tumour necrosis factor mediated release of plasminogen acitvator inhibitor-1 by human peritoneal mesothelial cells. Br J Surg 1994;81:214–216.
26.
Watson RW, Redmond HP, McCarthy J, Burke PE, Bouchier-Hayes D: Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg 1995;82:1060–1065.
27.
diZerega GS: Contemporary adhesion prevention. Fertil Steril 1994;61:219–235.
28.
Wiseman D: Polymers for the prevention of surgical adhesions; in Domb AJ (ed): Polymeric Site-Specific Pharmacotherapy. Chichester, Wiley, 1994, pp 369–421.
29.
Menzies D, Ellis H: The role of plasminogen activation in adhesion prevention. Surg Gynecol Obstet 1991;172:362–366.
30.
Vipond MN, Whawell SA, Scott-Coombes DM, Thompson JN, Dudley HAF: Experimental adhesion prophylaxis with recombinant tissue plasminogen activator. Ann R Coll Surg Engl 1994;76:412–415.
31.
Interceed (TC7) Adhesion Barrier Study Group: Prevention of postsurgical adhesions by Interceed (TC7), an absorbable adhesion barrier: A prospective, randomized multicenter clinical study. Fertil Steril 1989;51:933–938.
32.
Sekiba K, Obstetrics and Gynecology Adhesion Prevention Committee: Use of Interceed (TC7) absorbable adhesion barrier to reduce postoperative adhesion reformation in infertility and endometriosis surgery. Obstet Gynecol 1992;79:518–522.
33.
Becker JM, Dayton MT, Fazio VW, et al: Sodium hyaluronate-based bioresorbable membrane (HAL-F) in the prevention of postoperative abdominal adhesions: A prospective, randomized, double-blinded multicenter study. Am Coll Surg Meet, 1995.
34.
Diamond M: SeprafilmTM (HAL-FTM) reduces postoperative adhesions: Initial results of a multicenter gynecologic clinical study. 4th Congr Eur Soc Gynaecol Endosc, 1995.
1998
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.