Intraoperative field flooding with warm humidified CO2 may help to prevent adhesion formation after open surgery

Postoperative adhesion formation is a common, serious, and costly complication, which may cause organ dysfunction, difficult re-operations, and chronic pain. The formation of adhesions after open surgery is partly due to the perioperative exposure of the wound cavity to ambient air, which initiates various local processes that cause inflammation and cellular damage in mesothelial layers. These adhesiogenic processes include superficial desiccation, airborne bacterial contamination and subsequent wound infection, and exposure to atmospheric oxygen with ensuing hyperoxia and oxidative stress. Here, we describe how recent results from experimental surgical research imply that the adverse effects of air exposure during open surgery could be prevented by the use of intraoperative field flooding with warm and humidified carbon dioxide. If proven effective in a clinical trial, a decreased incidence of postsurgical adhesions would thus save a lot of suffering, time, and money for the patients and the healthcare system.