Adhesions in gynecologic surgery

The pathophysiology of adhesion formation continues to be perplexing. A delicate balance appears to exist between those wound factors that would initiate the physiologic process of peritoneal wound healing and those factors necessary for the lysis of fibrin, a major component of adhesions. Research continues to elucidate the roles of leukotrienes, prostaglandins, protein kinase-C, and transforming growth factors in adhesiogenesis. The ability to enhance plasmin's fibrinolytic activity or to impede plasminogen activator inhibitor factor may have important clinical ramifications in adhesiolysis. Clinical studies continue to address the effectiveness of intraperitoneal additives (dextran, lactated Ringer's solution, heparin) and barriers to adhesion formation (Interceed, TC7, Johnson & Johnson, New Brunswick, NJ; Gore-Tex, polytetrafluoroethylene, Gore & Assoc, Flagstaff, AZ). Surgical technique with attention to hemostasis, minimal trauma, proper suture selection, and peritoneal irrigation continues to be the mainstay in adhesion prevention.