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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2006 April;19(2):103-9
Peritoneal adhesions. A review of the literature
Gelmini R., Saviano M.
Dipartimento di Chirurgia Generale e Specialità Chirurgiche Università degli Studi di Modena e Reggio Emilia, Modena
The first descriptions of peritoneal adhesion syndromes in the medical literature are to be found with an abundance of detail in the anatomical pathology treatises of the 19th century as autopsy observations on the outcome of tubercular peritonitis. It was only at the end of the 19th century, with the development of abdominal surgery related to the introduction of anesthetics and antisepsis, that the first descriptions of this pathology as the possible cause of intestinal occlusion also began to appear in surgical texts, with specific references to various etiological hypothesis. Following an analysis of the literature, the authors focus on the clinical and socio-economic impact of postoperative peritoneal adhesions. In particular, the clinical syndromes, the risks, the complications and the repercussions arising out of the presence of peritoneal adhesions are examined. In recent years, numerous experimental and clinical studies have brought an understanding of the genesis of adhesions, as the sequelae of a process of peritoneal repair at the site of a trauma where local phenomena permit the organization of fibrin deposits on the peritoneal surfaces of adjacent organs and structures and it is an imbalance between fibrin formation and fibrinolysis capacity that appears to be the decisive pathogenetic element. Today, video-laparoscopic surgery can prove useful in the diagnosis and the treatment of chronic adhesion syndromes even though the mini-invasive approach seems to reduce but not eliminate the onset of postoperative adhesions. In the light of current pathogenetic knowledge of peritoneal adhesions, the strategies for preventing or, at least, reducing their development, by surgical tactics and the use of adjuvants, are pointed out.