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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Adhesions cause bowel obstruction, chronic abdominal pain, and infertility. In this review, the incidence, clinical signs, diagnostic procedures, and treatment of these sequels of abdominal surgery are discussed. Laparoscopic treatment of bowel obstruction, chronic pain, and infertility is feasible in selected patients and has been reported to cause fewer newly formed adhesions. Randomized controlled trials to compare open and laparoscopic surgery for adhesions should be executed with long-term follow-up to assess the success rates of adhesiolysis and compare the morbidity and mortality.
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PMID:Abdominal adhesions: intestinal obstruction, pain, and infertility. 1263 22

Adhesions between viscera and mesh may result in intestinal obstruction and fistulae formation. Fewer adhesions with sodium carboxymethylcellulose (SCMC)-coated polypropylene mesh (PM) has been reported, but impaired wound healing was the major concern. We investigated the adhesion-prevention effect of SCMC in different concentrations, as coating only on visceral face of PM and its effects on wound healing. A full-thickness abdominal wall defect was created in 28 rats, which were then divided into three groups. In Group I (control), the defect was repaired with PM only; in Group II and Group III, the defects were repaired with 1% and 1.6% SCMC-coated-PM, respectively. All animals were sacrificed at day 30, and histological evaluation and adhesion scoring were done. Animals in the group in which 1.6% SCMC-coated PM was used developed significantly fewer adhesions compared with other animals (P=0.04). Histological evaluation using a semiquantitative scoring system showed no difference between the groups in fibrosis and inflammation scores (P=0.9 and P=0.3, respectively), and thickness of fibrosis on mesh was also similar (P=0.5). SCMC in 1.6% concentration as coating only on the visceral face of PM reduced the incidence and severity of adhesions without impairing wound healing.
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PMID:Carboxymethylcellulose coated on visceral face of polypropylene mesh prevents adhesion without impairing wound healing in incisional hernia model in rats. 1268 27

PURPOSE: Lanreotide, a long-acting somatostatin analogue, inhibits intestinal, bile and pancreatic secretions and decreases intestinal motility. The purpose of this experimental study was to evaluate the effects of lanreotide on the healing of intestinal anastomoses following small bowel obstruction. METHODS: Two groups of 16 Wistar rats (average weight 310 g) were used. Basal diameters of ileus were measured prior to the ligation of the bowel, 15 cm from the ileocecal valve. Luminal fluid was also withdrawn proximal to the obstructed bowel for sodium and potassium analysis. Lanreotide was administered intramuscularly in a single dose (5.4 mg/kg) in the first group, while the same volume of saline was used in the control group. 48 h later rats were re-operated upon. Diameters of the obstructed segments were measured, and luminal fluid of the obstructed bowel was withdrawn and sodium and potassium levels were measured. A segment of 1 cm of the obstructed bowel was resected and end-to-end intestinal anastomosis was performed. Rats were sacrificed on day 7 following the second operation. Anastomoses were examined macroscopically and resected including a 2.5 cm of small bowel on either side. Bursting pressures were measured and the specimens were send for histological examination. RESULTS: The diameter of obstructed bowel increased significantly in both groups. The increase was more prominent in the control group (P < 0.001). Total luminal electrolyte contents for sodium and potassium were stastistically higher in the control group compared to the lanreotide group (P < 0.001). Adhesion formation was more extensive in the control group. Bursting pressures were significantly higher in the lanreotide group compared to the control group (P=0.003). Histological examination of anastomoses showed a more profound inflammatory reaction in the control group compared to the lanreotide group while microscopical healing of the anastomoses was almost the same in both groups. CONCLUSIONS: Lanreotide administration in rats with small bowel obstruction decreases significantly distension and electrolyte losses and seems to improve strength of small bowel anastomoses.
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PMID:Effects of lanreotide on the healing of small bowel anastomoses following obstructive ileus in rats. 1278 Jun 50

Adhesion formation is of major concern to the pelvic surgeon. Most patients develop postoperative adhesions regardless of whether the mode of access to the abdominal cavity is by laparoscopy or laparotomy. Infertility is related to adhesions in the pelvis in 15-20% of cases. Peritoneal adhesions are the main cause of mechanical bowel obstruction in 65-80% of cases and contribute to a large extent to health-care expenditures. To prevent the formation of postoperative adhesions, a variety of medications have been studied such as glucocorticoids, heparin, dextran 70, saline solution, antibiotics, promethazine, antihistamines, prostaglandin synthesis inhibitors, Ringer's lactate solution, calcium-channel blockers and barriers such as Interseed and Gore-Tex. Such adhesions can be induced when operating on myomas and endometriosis. Experimental and clinical studies have demonstrated various mechanisms of action to be involved in adhesion prevention when gonadotropin-releasing hormone agonists (GnRH-a) are used for treatment. The following have been demonstrated and suggested: (1) Hypoestrogenic condition was found in rats to be associated with decreased adhesion formation. This could be related to the influence on estrogen-dependent growth factors and growth modulators by reliable and constant inhibition of ovarian estradiol biosynthesis and secretion, but also non-competitive estrogen antagonism seems to play a role. (2) Treatment with GnRH-a reduces the growth hormone release stimulated by growth hormone-releasing hormone. (3) GnRH-a treatment influences neoangiogenesis by affecting vascular endothelial growth factor and basic fibroblastic growth factor. (4) GnRH-a reduce the basal rate of coagulatory processes. The frequency and extent of fibrin-generating and degrading processes are reduced. Activity of the plasminogen activating inhibitor is reduced, suggesting an improvement infibrinolytic reactivity. (5) GnRH-a use alters the vascular resistance index, pulsatility index and vascular peak velocity, and possible immune response. (6) Avoidance of bleeding can reduce fibrin and therefore decreases the matrix for invasion by fibroblasts. (7) GnRH-a reduce the degree of inflammation postoperatively. Adhesion prevention seems to be at its best when pre- and postoperative GnRH-a treatment is administered. At present, there are trends to operate without prior treatment with GnRH-a. Based upon the data available, it seems worthwhile to consider preoperative and also postoperative treatment with GnRH-a: pretreatment for at least 2-3 months seems to be indicated, and a similar time after operation, to block the events associated with adhesion formation.
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PMID:Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. 1562 74

Postoperative intraperitoneal adhesion formation is a major cause of intestinal obstruction, pain and infertility. This experimental study was designed to evaluate the degree of adhesion formation and peritoneal tissue levels of malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite and nitrate (NO) and the effect of aminoguanidine (AG) on these metabolite values after postoperative intraperitoneal adhesion formation in rats. A total of 21 adult male Wistar albino rats were randomly divided into three groups. Control rats were untreated; the AG group received AG 200 mg kg(-1) i.p. for 10 consecutive days intraperitoneally after surgery. The sham group was given 0.9% NaCl. The rats were killed on postoperative day 10. The peritoneal tissues were harvested to determine the tissue levels of MDA, GSH, and NO activity. For light microscopic evaluation, the cecum was removed. Adhesion formation scores in the AG group were significantly lower than those of the control and sham groups (p < 0.017, p < 0.026 respectively). In the AG-treated rats, tissue levels of MDA and NO were significantly lower than in the control group (p < 0.017). The levels of GSH in aminoguanidine-treated rats were significantly higher than those of the control group (p < 0.01). The severity of the inflammation was more prominent in the control group compared with the AG-injected rats. The results demonstrate that in this experimental model, intraperitoneal administration of aminoguanidine decreases the incidence and extent of peritoneal adhesions and causes a decrease in MDA and NO and an increase in GSH values.
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PMID:Protective effect of aminoguanidine against oxidative stress in an experimental peritoneal adhesion model in rats. 1599 Dec 62

The objective of this chapter is to evaluate the magnitude of the problems of adhesions in Gynecology, complications, cost for the health care, and methods to prevent adhesion formation. It contains a review of relevant literature on intra-abdominal adhesion, adhesion-reducing substances, and their related cost. Adhesions can cause infertility, abdominal pain, or bowel obstruction. The impact of adhesions to the health-care system is huge. The total cost of adhesion-related problems in the United States is more than dollar 1 billion dollars annually. Modification in surgical technique, such as the use of laparoscopy, can minimize adhesion formation. Another approach is by using adhesion-reducing substances. Many substances and materials have been used to decrease the adhesion formation; however, there remains no unequivocally effective adhesion-reducing substance. Also, its use is costly. To our knowledge, no study has been published to date that addresses the use of adhesion-reducing substances as relates to the risk of bowel obstruction or long-term costs to the health-care system.
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PMID:Adhesion in gynecology complication, cost, and prevention: a review. 1652 72

Intestinal obstruction is a rare cause of acute abdominal pain during pregnancy. We reviewed and analyzed the medical records of four pregnant women with intestinal obstruction, treated at the Department of Surgery in the Kaohsiung Medical University Hospital during a period of 19 years, between June 1984 and December 2002. Their ages ranged from 22 to 35 years (mean, 28 yrs). Three cases had had prior lower abdominal surgery. Adhesion was the unique finding in all four patients during the operation. Enterolysis was needed to release the intestinal obstruction in three of the patients; the fourth required resection and anastomosis of the ileum as a result of volvulus. Premature labor was prevented with tocolysis in two patients. The results of this study lead us to emphasize the importance of close observation and early surgery to avoid intestinal strangulation if a pregnant woman who develops intestinal obstruction has an old surgical scar on her abdomen. Premature labor may be avoided with tocolysis.
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PMID:Intestinal obstruction during pregnancy. 1657 May 64

Intestinal obstruction may be mechanical or non-mechanical (adynamic ileus). Adhesions and external hernias are the most common causes of obstruction in small intestine, whereas carcinoma, sigmoid diverticulitis, and volvulus are the most common causes in large intestine obstruction. Distension of the intestine caused by gas and fluid accumulation in the obstructed segment is the key pathophysiological mechanism initiating ileus with subsequent multiorgan failure and death. Surgery should always be undertaken if complete obstruction or strangulation is suggested and ileus is established. Before operation, the fluid and electrolyte balance should be restored and decompression instituted by means of a nasogastric tube. Delaying the operation because of improvement in patient well-being during resuscitation is only justified in those suffering from large intestine obstruction due to colorectal carcinoma. Purely nonoperative treatment is safe only in the presence of incomplete obstruction and best utilized in patients with postoperative adynamic ileus or repeated episodes of partial obstruction.
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PMID:[Ileus disease]. 1696 60

Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.
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PMID:Prevention of adhesions in gynaecological endoscopy. 1745 99

Consequences and complications of postsurgical intra-abdominal adhesion formation not including small bowel obstruction and secondary infertility are substantial but are under-exposed in the literature. Inadvertent enterotomy during reopening of the abdomen or subsequent adhesion dissection is a feared complication of surgery after previous laparotomy. The incidence can be as high as 20% in open surgery and between 1% and 100% in laparoscopy depending on the underlying disease. Delayed postoperative detection of enterotomy is a particular feature of laparoscopy associated with significant morbidity and mortality. Adhesions to the ventral abdominal wall are responsible for the majority of trocar injuries. Both trocar injuries and inadvertent enterotomies result in conversion from laparoscopy to laparotomy in almost 100% of cases. There is a paucity of data on other organ injury, such as liver laceration or bladder perforation. Dissecting adhesions before executing the planned operation takes on average 20 min, being one-fifth of the total operating time in patients having had previous open colorectal surgery. There is some evidence that postoperative morbidity and mortality of patients who need adhesiolysis is higher than that of patients with a virgin abdomen. The necessity to dissect adhesions is associated with increased hospital stay. Postsurgical adhesions are considered a main reason for conversion from laparoscopy to laparotomy in many types of procedures including laparoscopic colonic resection. Adhesion formation is part of the innate peritoneal defence mechanism in peritonitis. Abscess formation and bleeding, organ injury and fistula formation at 'on demand' relaparotomies are well-known complications after surgery for intra-abdominal sepsis associated with fibrinous adhesions. The clinical magnitude hereof is poorly researched. Postsurgical adhesions may cause pain as evidenced by pain mapping clinical experiments. Filmy adhesions between movable organs and the peritoneum appear to be worse in terms of generating pain. The high caseload of gynaecological and some colorectal practices suggest an enormous impact of adhesion-related chronic abdominal and pelvic pain on patient's wellbeing and socio-economic costs. The significant risk of inadvertent enterotomy, conversion to laparotomy and trocar injury, and the associated postoperative morbidity and mortality and increased length of hospital stay warrant routine informed consent of adhesiolysis related complications in patients scheduled for abdominal or pelvic reoperation.
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PMID:Consequences and complications of peritoneal adhesions. 1782 67


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