Background Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. Database A Medline search using "adhesions," "adhesiolysis," and "laparoscopy" as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. Discussion The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation.

Adhesions and adhesiolysis: the role of laparoscopy.

Effects of Physical Barriers in Prevention of Adhesions: An Incisional Hernia Model in Rats

Objective— To evaluate the efficacy of 1% sodium carboxymethylcellulose (SCMC) for prevention of experimentally induced abdominal adhesions in horses.



Study Design— Prospective, controlled, experimental study.



Animal Population— Twelve healthy adult horses



Methods— The effect of 1% SCMC on adhesion formation was evaluated in 12 healthy horses by using an established model of serosal trauma to induce intraabdominal adhesions. After ventral median celiotomy, 2 separate areas of the jejunum were abraded, and three 2–0 chromic gut sutures were placed in each abraded area. Jejunal resection and end-to-end anastomosis was performed at 2 sites distant to the abrasion sites. In treated horses (n= 6), 2 L of 1% SCMC was applied to the intestine before and after intestinal manipulation. In control horses (n= 6), 2 L of saline solution were applied to the intestine before and after surgical manipulation. All horses were euthanatized 10 days after surgery, and the abdominal cavity was evaluated for adhesion formation. The frequency of intraabdominal adhesions between groups was compared with a chi-square test. Statistical significance was set at P < .05.



Results— All control horses had intraabdominal adhesions. Fibrous adhesions were associated with both jejunal abrasion sites in 5 control horses. Fibrous adhesions were also associated with 1 or both jejunal anastomotic sites in 5 control horses. Only 1 treated horse developed adhesions at the jejunal abrasion sites, and no adhesions were present at the anastomotic sites in the treated horses. There were significantly fewer adhesions in the SCMC treatment group compared with the control group (P < .05).



Conclusion— In this experimental model, application of 1% SCMC reduced the frequency of intraabdominal adhesions at areas of serosal abrasion and at jejunal anastomotic sites.



Clinical Relevance— In horses at an increased risk for developing intraabdominal adhesions after intestinal surgery, the use of 1% SCMC during celiotomy may decrease the frequency of adhesion formation.

One Percent Sodium Carboxymethylcellulose Prevents Experimentally Induced abdominal Adhesions in Horses

Early recognition and treatment of acute abdominal pain along with advances in anesthesia, surgery, and perioperative care have decreased the morbidity and mortality associated with surgical treatment of intestinal diseases in horses. The improved outcome in horses undergoing exploratory celiotomy for surgically related intestinal diseases has resulted in more horse owners opting to pursue surgical treatment. Correspondingly, the clinical significance of long-term postoperative complications, such as postoperative adhesion formation, has concurrently become more apparent [1–3]. Despite numerous research and clinical investigations, adhesions continue to present clinical complications and challenges to the surgeon. Adhesions may form between apposing intestinal surfaces (serosal-serosal adhesions) (Fig. 1), from the intestine to the abdominal wall (serosalperitoneal adhesions), or between the omentum and intestine or peritoneum (omental adhesions). Fortunately, most postoperative adhesions are clinically silent and do not result in postoperative complications [4–6]. Adhesions become a clinical problem when fibrinous adhesions mature to restrictive fibrous adhesions and compress or anatomically distort the intestine, resulting in intestinal narrowing and preventing the normal passage of ingesta. Adhesions may also cause excessive tension on mesenteric attachments, resulting in signs of abdominal pain. Serosal or omental adhesions that do not directly distort or narrow the intestine may form blind loops or potential spaces in which intestine may become entrapped or incarcerated, predisposing these segments to obstruction or strangulation.

https://www.vetequine.theclinics.com/article/S0749-0739(03)00053-1/pdf

Prevention and treatment of gastrointestinal adhesions.

A biomaterial composed of carboxymethylcellulose, poly(ethylene oxide), and calcium can be prepared in a variety of ways to reduce fibrin deposition and adhesion formation. This biomaterial platform can be formulated into a flowable gel with tissue adherence appropriate for use in minimally invasive surgery. The device remains at the site of placement even in gravitationally dependent areas. A peridural formulation was shown in preclinical studies to be safe and effective in reducing adhesions to dura following spinal surgery. A peritoneal formulation used on pelvic organs following peritoneal cavity surgery was also shown to be safe and effective. A clinical feasibility study showed that patients with severe back pain and lower extremity weakness treated with the peridural formulation, applied over their nerve roots following laminectomy or laminotomy, experienced significantly reduced symptoms when compared with surgery-only controls. The peritoneal formulation was shown in two multicenter feasibility studies of women undergoing pelvic surgery to significantly reduce adhesion formation when compared with surgery-only controls. Confirmation of the feasibility studies awaits results from pivotal clinical trials. These formulations were safe, effective, and easy to use. This biomaterial provided a benefit to patients undergoing surgery where postsurgical adhesion formation is a concern.

A modern biomaterial for adhesion prevention.

Intraperitoneal sodium carboxymethylcellulose administration prevents reformation of peritoneal adhesions following surgical lysis.

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Intraperitoneal sodium carboxymethylcellulose administration prevents reformation of peritoneal adhesions following surgical lysis.