INTRODUCTION

摘要

Adhesions are a common consequence of abdominal and pelvic surgery. Cesarean birth and hysterectomy are the two most common surgical procedures performed in the United States on reproductive-age women (Centers for Disease Control and Prevention [CDC], 2009). Intra-abdominal adhesions occur in 55 percent to 100 percent of patients with abdominal or pelvic surgery as a result from peritoneal trauma and aberrant wound healing processes (Liakakos, Thomakos, Fine, Dervenis, & Young, 2001; Lyell, 2011). Both laparotomy and laparoscopic procedures result in adhesion formation.Due to the significant morbidity associated with adhesion formation, great efforts have been made to alter the pathogenic process (described in part one of this series). These strategies may generally be described as (1) minimizing peritoneal injury during surgery, (2) reducing the local and inflammatory response, (3) inhibiting the coagulation cascade and promoting fibrinolysis and (4) using barriers for separation of surfaces at high risk for adhesion formation. Surgeons make individual judgments based on safety, perceived benefits and cost when deciding whether to use adhesion-reduction products. Clinical and cost evidence to reduce the burden of adhesion-related re-admissions should also be considered.