Introduction: Quality of pelvic surgery and postoperative adhesions
Our understanding of mesothelial cell repair and of the surgical trauma to the entire peritoneal cavity permits virtually adhesion-free surgery by combining conditioning and a barrier and dexamethasone.
Volume 106, Issue 5, Pages 991-993
Philippe R. Koninckx, M.D., Victor Gomel, M.D.
The health care and the emotional cost of postoperative adhesions that frequently cause chronic pain, infertility, bowel obstruction, and repeat surgery are well known. Our understanding of the pathophysiology of adhesion formation and of its prevention has evolved from good surgical practice based on microsurgical principles—barriers to keep denuded areas separated, the prevention of mesothelial cell damage and of acute inflammation in the entire peritoneal cavity. Oxidative stress, in the surgical lesions and in the peritoneal cavity has an important role in adhesion formation by slowing down repair. This has resulted in virtually adhesion-free surgery, in addition with less CO2 resorption, less postoperative pain, and a faster recovery. The clinical efficacy had been demonstrated by higher pregnancy rates (PRs) using microsurgical tenets.