Prevention / Treatment of Adhesions...

From: Helen Dynda (olddad66@runestone.net)
Wed Oct 4 16:13:54 2000


This information is found at the following web site:

http://www.ethiconinc.com/womens_health/product/adhesions/prev_fr.htm

PREVENTION / TREATMENT OF ADHESIONS:

[] Surgical Techiques to Minimize Adhesion Formation:

1.) Achieve meticulous hemostasis

2.) Maintain vasularity

3.) Moisten tissues

4.) Avoid dry sponges

5.) Minimize tissue handling

6.) Use fine, nonreactive sutures

7.) Avoid peritoneal grafts

8.) Minimize foreign bodies

Even though the most meticulous surgical and microsurgical techniques cannot eliminate the formation of adhesions, the following steps can be taken to reduce adhesion formation:

1.) Achieve meticulous hemostasis: Inadequate hemostasis and the resultant fibrin deposition promote adhesion formation.

2.) Maintain vascularity: Limiting ischemia supports fibrinolysis.

3.) Moisten tissues: Frequent irrigation and the use of moist sponges prevent desiccation of tissue. Ringer's lactate or other irrigating solutions also eliminate any residual talc, lint, or blood clots, which may provide a nidus for a foreign body reaction, inflammation, and adhesion formation.

4.) Avoid dry sponges: Use of gauze and dry sponges should be avoided because they may damage the peritoneal surface and leave a foreign body behind.

5.) Minimize tissue handling: Manipulating tissue increases the possibility of vascular and tissue damage. When direct manipulation of the peritoneum is necessary, use either atraumatic instruments or fingers. In addition, cutting and coagulating should be kept to a minimum to reduce the possibility of trauma and maintain vascularity.

6.) Use fine, nonreactive sutures: To minimize foreign body reactions use the smallest size of suture composed of synthetic material.

7.) Avoid peritoneal grafts: Grafting increases the risk of peritoneal trauma while decreasing vascularity.

8.) Minimize foreign bodies: Foreign bodies may damage the peritoneal surface, lead to inflammation, and ultimately result in adhesion formation.

Hydroflotation, or pouring volumes of instillates into the pelvic cavity at the end of a procedure, is used to reduce the formation of adhesions. In their classic study, Shear et al(1) demonstrated that crystalloid, such as Ringer's lactate and normal saline, is absorbed from the peritoneal cavity of dialysis patients at a rate of about 35 ml per hour. For example, 300 ml of crystalloid would be absorbed in 8.5 hours. Thus, since adhesions can form up to 5 days after surgery, even a large volume of peritoneal instillate would be absorbed well before that period of time.


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