Gerald Anand Raja
BACKGROUND Peritoneal adhesions can be defined as abnormal fibrous bands between organs or tissues or both in the abdominal cavity that are normally separated. Adhesions may be acquired or congenital; however, most are acquired as a result of peritoneal injury, the most common cause of which is abdominopelvic surgery. Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies from one patient to another and is most dependent on the type and magnitude of surgery performed as well as whether any postoperative complications develop. Fortunately, most patients with adhesions do not experience any overt clinical symptoms. For others, adhesions may lead to any one of a host of problems and can be the cause of significant morbidity and mortality.
MATERIALS AND METHODS
This is a retrospective study of 50 patients admitted in Government Royapettah Hospital with adhesive bowel obstruction between September 2008 to September 2010. All patients were admitted and managed either conservatively or surgically.
1. Adhesive bowel disease is the most common cause for bowel obstruction followed by hernias.
2. Increased incidence is noted in females.
3. Increased incidence of adhesions was documented in gynaecological and colorectal surgeries.
4. Below umbilical incisions have higher propensity for adhesion formation.
5. Laparotomies done for infective aetiology have higher adhesion risks.
6. Most of adhesive obstructions can be managed conservatively.
7. Adhesiolysis preferably laparoscopic can be done. For gangrenous bowel resection and anastomosis or ostomy done.
8. Given the above risk factors, adhesive bowel disease can be prevented to a certain extent.
CONCLUSION The formation of peritoneal adhesions continues to plague patients, surgeons and society. Although, research in this area is ongoing, there is currently no method that is 100% effective in adhesion prevention nor is there any way to permanently remove them once they have formed. Newer products are being developed that seem promising, but their efficacy has yet to be proven in clinical trials. Until then, surgeons should continue to be meticulous in their operative technique and should seek to minimise injury to the peritoneal surface.