Adhesive disease of the abdominal cavity: etiomorphopathogenesis, clinic, diagnosis, treatment, and prevention at the present stage

During surgery of the gastrointestinal tract, peritoneal adhesions are detected in 80–90% of cases, including in open surgical interventions, and abdominal adhesions occur in 70–90% of patients, with laparoscopic — in 24–35% of patients. The number of deaths from adhesive disease ranges from 14 to 52% and reaches 68% in patients aged >60 years with concomitant pathology.

The main etiological factors of adhesions are mechanical, chemical, physical, and infectious effects. The pathogenesis of adhesion formation includes three processes: inhibition of fibrinolytic and extracellular matrix degradation systems; inflammatory reaction with cytokine production, mainly transforming growth factor β1; and tissue hypoxia due to interruption of blood supply to mesothelial cells and submesothelial fibroblasts. Clinically, adhesive disease of the abdominal cavity is characterized by dyspeptic disorders in the early stages and is accompanied by intestinal obstruction in advanced cases. Adhesive disease treatment can be performed using conservative therapy or surgical intervention. To date, prevention is the most preferred method to impede the consequences of the development of adhesive disease.

Despite improvements in surgical techniques and the development of new approaches to treatment and diagnosis, adhesions remain an inevitable consequence of intra-abdominal operations. Understanding the pathogenesis of the formation of the adhesive process and adhesion and possibility of their transformation, especially at the cellular and molecular level, is beneficial for the development of more effective methods of treatment and prevention of adhesive disease of the abdominal cavity.