Several follow-on studies have since confirmed the impact of adhesions and related complications on the number of hospital re-admissions. They found that 5.7% of re-admissions were directly related to adhesions with nearly a quarter of these being in the first year after surgery. The Surgical and Clinical Adhesions Research (SCAR) group performed the first large retrospective cohort study of over 21,000 patients who underwent open abdominal or pelvic surgery. It is proposed that adhesions form in 79–90% of patients who have open abdominal or pelvic surgery. Many patients will be clinically asymptomatic post-surgery however, others will experience high morbidity, significant health issues, and possible hospitalisation for adhesion-related complications including bowel obstruction, female infertility, and chronic pelvic pain as well as difficulties with any repeat surgery. Although surgery is the main inducer of adhesions, they can also occur after inflammatory episodes such as peritonitis and endometriosis. They can take several forms, ranging from thin translucent films to thick, organised cords however, histologically they are well vascularised, innervated with varying degrees of adipose tissue, dense collagen foci and inflammatory cells.
Lastly, we highlight examples of where local tissue specialisation may determine a particular response of peritoneal cells to injury.Īdhesions are bands of scar tissue connecting opposing organs together or to the inner abdominal cavity wall. We discuss changes in mesothelial biomolecular marker expression during peritoneal development, which may help, in part, to explain findings in adults from lineage tracing studies using experimental adhesion models. Here, we summarise recent advances in our understanding of serosal repair and adhesion formation with an emphasis on molecular mechanisms and novel gene expression signatures associated with these processes. Emerging evidence suggests that mesothelial cells do not simply form a passive barrier but perform a wide range of important regulatory functions including maintaining a healthy peritoneal homeostasis as well as orchestrating events leading to normal repair or pathological outcomes following injury.
#STEVEN GRESO SEPTIC SYSTEM DESIGNER WA FULL#
Our understanding of the full pathophysiology of adhesion formation is limited by the fact that the mechanisms regulating normal serosal repair and regeneration of the mesothelial layer are still being elucidated. Adhesions affect and involve the peritoneal lining of the abdominal cavity, which consists of a continuous mesothelial covering of the cavity wall and majority of internal organs. Post-surgical adhesions are internal scar tissue and a major health and economic burden.
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