Etiology of Adhesion Formation

Surgically induced adhesions are a complication of invasive surgical procedures (48). Adhesions induced by either trauma, surgical or otherwise, and pathology (i.e., endometriosis) can lead to a variety of complications including infertility, bowel obstruction, pain, impaired joint mobility, and unintended complications during reoperation (49-53). The etiology of surgically induced adhesions is thought to be a result of incidental trauma caused by tissue manipulation (54), desiccation (54), tissue ischemia, and a foreign body reaction to particulates (55-57). This damage leads to a wound healing response that results in the production of a serous exudate that leads to fibrin clot production (58-60). If the fibrin clot is relatively short lived then it is resorbed with concomitant normal wound repair. If, however, the fibrin clot resides for a longer time period then cells of fibroblastic phenotype are recruited to the site. These cells begin to generate collagen leading to a scar-like tissue and adhesion formation. Over time remodeling of this tissue can lead to contraction and stricture, which if strategically placed around the viscera can lead to bowel obstruction. Therefore, reduction of adhesion formation can improve the outcome of a procedure and significantly reduce the complexity of reoperations (61).

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