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Postoperative peritoneal adhesions in adults and their prevention

Authors
Alan H DeCherney, MD
Senthil Kumar, MS, FRCS (Ed), FRCS (Gen Surg)
Section Editors
Tommaso Falcone, MD, FRCSC, FACOG
Hilary Sanfey, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Postoperative peritoneal adhesions have important consequences to patients, surgeons, and the health system. The adhesions that form in the abdomen following abdominal or pelvic surgery are a normal response to injury of the peritoneal surfaces during surgery, and although adhesions have some beneficial effects, they also cause significant morbidity, including adhesive small bowel obstruction, female infertility, chronic abdominal pain, and increased difficulty with subsequent surgery [1,2]. These issues have refocused attention on our understanding of adhesions, their clinical consequences, and methods of prevention. A number of animal studies and human interventional trials have evaluated a variety of techniques and materials designed to reduce and prevent postsurgical adhesions. Only a handful of agents have been proven safe and effective in humans, and fewer have an evidence base that justifies routine use.

The epidemiology, pathogenesis, approach, and importance of preventing postoperative peritoneal adhesions in adults are reviewed here. The diagnosis and management of small bowel obstruction and infertility are discussed elsewhere. (See "Management of acute perioperative pain" and "Epidemiology, clinical features, and diagnosis of mechanical small bowel obstruction in adults" and "Evaluation of female infertility".)

INCIDENCE AND BURDEN

Postoperative adhesions cause significant morbidity, including bowel obstruction, female infertility, and chronic abdominal and pelvic pain [3-6].

Intestinal obstruction – Adhesions are the most common cause of intestinal obstruction in Western countries [7-9]. The incidence varies widely with the nature of the index surgery and the duration of follow-up [7,10-13]. Open gynecologic procedures, ileal pouch-anal anastomosis, and open colectomy are associated with the highest risk of adhesive small-bowel obstruction [14]. The incidence of small bowel obstruction resulting from postoperative adhesions increases with each subsequent procedure performed in the management of bowel obstruction. In one national study 5.7 percent of 21,347 readmissions were classified as relating directly to adhesions, and 3.8 percent required operation [12]. The risk factors associated with small bowel obstruction due to adhesions are discussed separately.

Infertility – Infertility in women can result from pelvic adhesions, which can interfere with ovum capture and transport or from tubal or intrauterine adhesions, that hinder sperm transport or embryo implantation. Whereas pelvic peritoneal adhesions and tubal abnormalities are each responsible for about 10 percent of cases of female infertility, intrauterine adhesions are a relatively rare cause of infertility. (See "Overview of infertility", section on 'Causes of infertility' and "Intrauterine adhesions".)

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Jul 01 00:00:00 GMT+00:00 2015.
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