Postoperative adhesions are fibrotic bands that form between tissues and organs following surgical procedures, particularly in the abdominal and pelvic cavities. These adhesions are a major cause of morbidity, leading to complications such as chronic abdominal pain, infertility, and intestinal obstruction Arung et al. (2011) Morris et al., 2017).
The pathophysiology of postoperative adhesions involves a cascade of events regulated by various cellular and humoral factors, including insufficient peritoneal fibrinolytic capacity (Hellebrekers & Kooistra, 2011). The formation of postoperative adhesions is a natural consequence of surgical tissue trauma and healing (“Control and prevention of peritoneal adhesions in gynecologic surgery”, 2006). Animal studies have shown that administration of TGF- to the postoperative abdomen enhances the formation of adhesions, while blockade of TGF-1 via inhibitory antibody treatment decreases the formation of adhesions (Boland & Weigel, 2006).
Furthermore, it has been suggested that insufficient peritoneal fibrinolytic capacity is the main factor in determining postoperative adhesion formation (Hellebrekers & Kooistra, 2011). Despite meticulous surgical techniques, postoperative adhesions develop in the majority of patients undergoing abdominopelvic surgery (Diamond, 2016).
To prevent the formation of postoperative adhesions, various strategies have been proposed, including the use of bioabsorbable materials (Hamaji et al., 2015), ovarian suspension in patients undergoing laparoscopic surgery for endometriosis (Giampaolino et al., 2019), and pharmacologic agents such as anti-inflammatories, antiestrogens, and antioxidants (Öner & Ulug, 2015). Additionally, the use of neurokinin-1 receptor antagonists (Reed et al., 2008), naproxen nanoparticle-loaded thermosensitive chitosan hydrogel (Wang et al., 2019), and traditional Japanese medicine Tokita et al. (2011) have also been investigated for their potential in preventing postoperative adhesions.
Moreover, the effectiveness of sodium hyaluronate, sesame oil, and liquid paraffin in preventing postoperative surgical adhesion formation has been evaluated (Khorshidi et al., 2017; Kataria & Singh, 2016). Other studies have examined the use of bioresorbable hyaluronate-carboxymethylcellulose membranes (Mueller et al., 2000), interferon γ, and plasminogen activator inhibitor 1 Ohashi et al. (2014) as potential preventive measures.
In conclusion, the prevention of postoperative adhesions is a complex and multifaceted issue, and various approaches have been explored to address this challenge. Further research, including pre-clinical and clinical studies, is necessary to evaluate the effectiveness of these prevention strategies and to develop comprehensive guidelines for their implementation.