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Abdominal Adhesions: Current and Novel Therapies
Abstract
An adhesion occurs when two tissues that normally freely move past each other attach via a fibrous bridge. Abdominal adhesions place a tremendous clinical and financial burden on public health. Adhesions develop after nearly every abdominal surgery, commonly causing female infertility, chronic pelvic pain, and, most frequently, small bowel obstruction. A National Hospital Discharge Survey of hospitalizations between 1998 and 2002 reported that 18.1% of hospitalizations were related to abdominal adhesions annually accounting for 948,000 days of inpatient care at an estimated cost of $1.18 billion. This review discusses the current or proposed therapies for abdominal adhesions. While many therapies for abdominal adhesions have been attempted, the need for a definitive therapy to prevent or even reduce abdominal adhesions still exists.
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“Biological coatings can be used to reduce the adhesion between biological tissues [154].”
From Mussel-Inspired Injectable Adhesive Hydrogels for Biomedical Applications (2024) · cites this paper as [154]
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Electrospun polymer micro/nanofibers as pharmaceutical repositories for healthcare
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Fatehi Hassanabad, A., Zarzycki, A. N., Jeon, K., Dundas, J. A., Vasanthan, V., Deniset, J. F., & Fedak, P. W. M. (2021) · Biomolecules · doi:10.3390/biom11071027 · Cited by 178
“Interceed has several limitations, including that all blood and peritoneal fluid [255] in the abdomen must be cleared before application, while folding or misplacement of Interceed can also induce adhesion formation [256].”
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Polymers for cell/tissue anti-adhesion
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“They continue proliferating until the MC islands connect with each other to complete the mesothelial repair, which usually takes 5-7 days [39,40].”
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“Considerations for adhesion prevention should be based upon an understanding of peritoneal repair, and what goes awry when adhesions develop, as briefly summarized below [1–3].”
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“112 In this regard, the nonadhesive nature of MC offered a distinctive advantage over other fluid and gel barriers (e.g., hyaluronate, PEO, or fibrin glue 112,113 ).”
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“Drugs such as corticosteroids inhibit fibrinolytic activity and may actually support adhesion formation (Ward and Panitch, 2011), which might contribute to an unacceptably high incidence of anastomotic leaks.”
BackgroundBiomaterials to Prevent Post-Operative Adhesion
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“Physical barriers prevent unnecessary contact by blocking surgical sites from other organs [7], and most of the physical barrier medical products are decomposed and absorbed in the body [25].”
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“However, to date no effective pharmacological agent has become available for human use [26].”
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“[25] and some have been FDA approved [26,27].”
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“However, in horses, not all surgical procedures can be performed in this manner [5, 25, 31].”
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“and the inflammatory system play major roles in the mechanism of abdominal adhesion formation [2, 14, 15].”
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Rahmanian-Devin, P., Rakhshandeh, H., Rahimi, V. B., Sanei-Far, Z., Hasanpour, M., Memarzia, A., Iranshahi, M., & Askari, V. (2021) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2021/5945101 · Cited by 41
“The surgical technique is the first method for adhesion treatment; however, it is insufficient alone [12].”
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“Various formulations of film or gel anti-adhesion agents are used to prevent tissue adhesion after abdominal operations [3].”
BackgroundPeripheral serotonin regulates postoperative intra-abdominal adhesion formation in mice
Bi, J.-B., Zhang, S., Du, Z., Zhang, J., Deng, Y., Liu, C., & Zhang, J.-Y. (2017) · Scientific Reports · doi:10.1038/s41598-017-10582-w · Cited by 41
Metal and light free “click” hydrogels for prevention of post-operative peritoneal adhesions
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Adhesions after laparoscopic myomectomy: Incidence, risk factors, complications, and prevention
de Wilde, R.-L., Herrmann, A., la Roche, L. A. T.-D., Krentel, H., Cezar, C., de Wilde, M. S., & Devassy, R. (2020) · Gynecology and Minimally Invasive Therapy · doi:10.4103/gmit.gmit_87_20 · Cited by 57
“These agents include antibiotics, calcium channel blockers, colchicine, crystalloid solutions, nonsteroidal anti-inflammatory drugs, salicylates, progestogens, gonadotropin-releasing hormone agonists, antihistamines, growth factor inhibitors, recombinant plasminogen activator, Vitamin E, and even honey.[48,50-53]”
BackgroundSprayable anti-adhesive hydrogel for peritoneal macrophage scavenging in post-surgical applications
Song, W., Lee, C., Jeong, H., Kim, S., & Hwang, N. S. (2024) · Nature Communications · doi:10.1038/s41467-024-52753-0 · Cited by 37
“Physical barriers directely protect injured organs and prevent the formation of adhesion bands between organs 13 .”
BackgroundLiu, C.-D., Lu, Q., Zhang, Z.-Q., Xue, M., Zhang, Y.-Z., Zhang, Y., Wang, H.-L., Li, H.-J., Zhou, Y.-F., Zhang, Z.-Y., et al. (2015) · Journal of minimally invasive gynecology · doi:10.1016/j.jmig.2015.04.011 · Cited by 37
“002 Ethicon), polyethylene glycol hydrogel (CoSeal; Baxter International, Deerfield, IL), and Hyalobarrier [7,9,12,15].”
BackgroundMethodInfluentialZou, Y., Yue, P., Cao, H., Wu, L., Xu, L., Liu, Z., Wu, S.-Q., & Ye, Q.-F. (2023) · Carbohydrate Polymers · doi:10.1016/j.carbpol.2023.120543 · Cited by 36
Soltany, S. (2020) · Naunyn-Schmiedeberg's Archives of Pharmacology · doi:10.1007/s00210-020-01961-8 · Cited by 36
Hu, W., Zhang, Z., Zhu, L., Wen, Y., Zhang, T., Ren, P., Wang, F., & Ji, Z. (2020) · ACS Biomaterials Science & Engineering · doi:10.1021/acsbiomaterials.9b01333 · Cited by 46
Mao, Y., Wang, F., Li, Y., Guidoin, R., Wang, L., & Wang, F.-J. (2020) · doi:10.1016/j.apsusc.2020.146104 · Cited by 35
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Therapeutic application of electrospun nanofibrous meshes.
Kim, H. S., & Yoo, H. (2014) · Nanomedicine · doi:10.2217/nnm.13.224 · Cited by 35
Halofuginone infused keratin hydrogel attenuates adhesions in a rodent cecal abrasion model.
Peyton, C., Keys, T., Tomblyn, S., Burmeister, D., Beumer, J., Holleran, J. L., Sirintrapun, J. S., Washburn, S., & Hodges, S. (2012) · Journal of Surgical Research · doi:10.1016/j.jss.2012.07.053 · Cited by 35
“[4] Ward BC, Panitch A.”
BackgroundResultInfluentialNovel thermosensitive hydrogel for preventing formation of abdominal adhesions
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Evaluation of the rabbit as an experimental model for human uterine synechia
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Metadata
- Authors
- Ward, B. C., & Panitch, A.
- Affiliations
- Purdue University West Lafayette (US)
- Corresponding author
- Panitch, Alyssa
- Venue
- Journal of Surgical Research
- Publisher
- Elsevier BV
- Published
- 2011-01
- Volume
- 165
- Issue
- 1
- Pages
- 91-111
- ISSN
- 0022-4804 (ISSN-L)
- OpenAlex
- W2122017924
- Cited by
- 249
- References
- 315
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 13 · 2023: 18 · 2022: 17 · 2021: 14 · 2020: 18 · 2019: 19 · 2018: 21 · 2017: 18 · 2016: 15 · 2015: 16 · 2014: 21 · 2013: 12 · 2012: 10
- FWCI
- 1.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Surgical Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K25HL074968)
- National Institute of General Medical Sciences (GM 077229, T32GM077229)
- Topics
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Health Sciences › Medicine › Surgery › Surgical Sutures and Adhesives
- Keywords
- peritoneal adhesions, postoperative adhesions, adhesion prevention, small bowel obstruction, female infertility, chronic pelvic pain, abdominal surgery complications
- MeSH terms
- Abdomen, Tissue Adhesions, Animals, Cellulose, Oxidized, Humans, Hyaluronic Acid
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