Peritoneal adhesions after laparotomy: prophylactic measures

Abdominal adhesions are due to a locally decreased peritoneal fibrinolytic capacity occurring mainly in ischemic areas of the peritoneum. They help to guarantee the supply of blood to these areas, acting as a protective mechanism ("vascular graft"). With respect to abdominal surgery a general suppression of the ability to form adhesions would therefore seem to be questionable. We consider the currently employed or discussed methods with their advantages and disadvantages. No optimal solution to the problem of adhesions has been found so far. Nevertheless, appropriate surgical technique can permit us to control adhesion formation to a certain degree. If adhesions are unavoidable, placement of the greater omentum should be done carefully in the areas of risk.