Achieve meticulous hemostasis: Inadequate hemostatsis and the resultant
fibrin deposition promote adhesion formation. Maintain vascularity:
Limiting ischemia supports fibrinolysis. 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. Avoid dry
sponges and 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
minumum to reduce the possibility of trauma and maintain vascularity.
Use fine, nonreactive sutures: To minimize foreign body reactions, use
the smallest size of suture composed of synthetic material. Avoid
peritoneal grafts: Grafting increases the risk of peritoneal trauma
while decreasing vascularity. Minimize foreign bodies: Foreign bodies
may damage the peritoneal surface, lead to inflammation, and ultimately
result in adhesion formation. Minimally invasive surgery results in
much less tissue irritation than conventional open techniques, with the
result of a much faster recuperation for the patient, as well as a
lesser likelihood of further adhesion formation. But what happens when
I put off surgery until something shuts down? The adhesions are too
dense and therefore the laparoscopy is difficult to use. Laparotomy
again, thus the adhesion cycle. Due to the inevitability of adhesion
formation, should the surgeon concentrate their efforts on intervening
at varying points in the pathway of adhesion formation? Sherry Marie