Abdominal Adhesions: From Formation to Prevention - Part One

Abdominal adhesions are still a major surgical problem for their incidence, clinical consequences, social costs as well as medicolegal implications. Most of the adhesions are postoperative, especially after colon-rectal surgery. Given the increasing number of surgical procedures performed and the increase in the average age of patients undergoing surgery, adhesions are also a problem in term of rehospitalizations directly or probably related. Readmissions mean the use of health care system resources. The peritoneal damage during surgery is the first pathophysiologic step that unleashes an acute local inflammation resulting in activation of a complex cytochemistry cascade. Adhesion development is secondary to an imbalance between fibrin formation, part of the healing process, and fibrinolysis: this is caused by increased levels of molecules inhibiting plasminogen and contemporaneous reduction of those activating it. Video laparoscopic surgery is also associated to this modified balance that determinates a pro-fibrotic state. Finally, we analyze adhesions classification systems.