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Small Bowel Obstruction
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
As the disease is persistent and seemingly unavoidable, there may be hope for a decreased burden of disease in an increasingly minimally invasive era. Operative technique and handling of the bowel has been attributed to the formation of adhesions. This thought process can be inferred from the results from Miller: colorectal procedures being more causative for obstruction than appendectomy, where there is a more focused exploration of the abdomen. Laparoscopic surgery has been demonstrated to be four times less likely to cause adhesive bowel obstruction requiring hospital admission (Angenete et al., 2012). Although minimally invasive procedures have higher index costs, the scales tend to balance at time of discharge. If minimally invasive surgery induces less tissue trauma and therefore causes fewer adhesions, this should be considered when planning operative needs, especially knowing the long-term consequences and recurrence of adhesive small bowel disease. If adhesive disease is inevitable, one should attempt to obviate or at least diminish that risk.
Hematopoietic Stem Cell Transplantation in Patients with Autoimmune Bullous Skin Disorders
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Cicatricial pemphigoid has recurring blisters on mucous membranes or on skin near orifices (mouth, oropharynx, nasopharynx, esophagus, genitals, and conjunctiva).1 The loss of function due to scarring and adhesions often necessitates surgical interventions. Genital areas, conjunctivae, larynx, pharynx and esophagus involvement causes significant morbidity. Brunsting and Perry described a variant of CP characterized by deep skin bullous lesions involving the head and neck that heal with scars.13
Pelvic Congestion Syndrome and Pelvic Adhesions
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
María Ángela Pascual, Jean L. Browne
Adhesion syndrome or pelvic adhesions, also known as peritoneal inclusion cysts and benign cystic mesothelioma among other names (which are confusing but all related to the same disease),21 is defined by symptoms and signs borne by intra-abdominal adhesions. Intraperitoneal adhesions are fibrous scar bands that develop between the surface of abdominal organs, tissues, and the peritoneum (Figure 8.20). Inflammation due to infection, surgery, endometriosis, or tumor disease may give rise to these scar bands.
The potential association between metabolic syndrome and risk of post-surgical adhesion
Published in Archives of Physiology and Biochemistry, 2023
Gordon A Ferns, Milad Shahini Shams Abadi, Mohammad-Hassan Arjmand
Adhesions or fibrotic scar formation is a common problem after many kinds of surgeries include abdominal/pelvic, gynecological, urological, orthopaedic, ENT operation, and even peritoneal dialysis. Adhesion bands are defined as abnormal fibrotic bands that are generated between adjacent tissues and the surface of organs after surgery (Braun & Diamond 2014). Bowel obstruction, infertility due to obstruction of the uterus and fallopian tubes, chronic pain, lack of access to the operation areas in subsequent surgeries, and high cost of hospitalisation are complications of post-surgical adhesions, and this is also associated with an increased mortality (Van Goor 2007, Kim et al. 2017). Hypoxic conditions during surgeries, longer operation times, and infections are reported to be the most important factors related to post-surgical adhesion formation (Molinas & Koninckx 2000, Lundorff et al. 2015). Despite using various preventive and therapeutic strategies that include new surgical equipment and techniques such as laparoscopy, biological barriers like Seprafilm, and the administration of fibrinolytic and anti-inflammations agents, post-surgical adhesion remains an important challenge for surgeons. Many studies have attempted to identify the risk factors and pathogenesis of post-surgical adhesion but there are largely unknown and more studies are needed to find the associations between pathological characteristics with intensifying formation of fibrotic bands.
Hyperglycaemia and the risk of post-surgical adhesion
Published in Archives of Physiology and Biochemistry, 2022
Gordon A. Ferns, Seyed Mahdi Hassanian, Mohammad-Hassan Arjmand
Post-operative abdominal adhesions present a challenge for patients undergoing abdominal or pelvic surgery and their surgeons. Adhesion formation is characterised by the development of fibrotic bands and pathological junctions between different organs or intra-abdominal organs to the abdominal wall. These fibrotic bands can lead to adhesions between organs and may lead to the disruption in the function of organs (Diamond and Freeman 2001, Arung et al.2011). Postoperative adhesion occurs in majority of cases following abdominal and pelvic surgeries (Menzies and Ellis 1990, Coccolini et al.2013). Serious problems are created by adhesion bands for patients such as intestinal obstruction (Menzies 1992), infertility (Ward and Panitch 2011), pelvic pain (Sulaiman et al.2000), repeated surgeries (Coleman et al.2000), and economic costs (the Surgical and Clinical Adhesions Research (SCAR) Group-2005, Parker et al. 2005). There are many studies of the pathogenesis of fibrotic bands post-operatively, but there is much unknown about the mechanisms involved in this disorder, for example why the intensity of adhesions is different in individuals with similar surgical procedures.
Endostatin in fibrosis and as a potential candidate of anti-fibrotic therapy
Published in Drug Delivery, 2021
Zequn Zhang, Xi Liu, Zhaolong Shen, Jun Quan, Changwei Lin, Xiaorong Li, Gui Hu
Postoperative adhesion (POA) is a manifestation of assorted aberrant histologic proliferation, characterized by hyperplastic fibrous tissue adherence to adjacent tissues and organs (Figure 6). Fibrotic adhesion bands may have various appearances, ranging from thin-layer slices to thick bands with neovascularization. More than 90% of patients undergoing abdominal surgery develop varying degrees of abdominal adhesions, which lead to complications like chronic abdominal pain, intestinal obstruction, and female infertility (Arung et al. 2011; Hellebrekers & Kooistra 2011). Besides, adhesion formation secondary to ligament and tendon healing may restrict joint movement. Moreover, POA secondary to open-heart surgery may make the pericardium fibrotic and thickened, resulting in constrictive pericarditis, which critically influences cardiac function. Furthermore, adhesions that occur after plastic surgery may seriously diminish therapeutic efficacy and fail to achieve desired outcomes. These complications frequently require multiple hospital admissions, increasing the burden on the patient and the healthcare system (ten Broek et al. 2013). These facts suggest that POA is an important clinical problem with potentially serious outcomes. Existing anti-adhesion strategies include reducing intraoperative damage, physical barriers, and anti-adhesion drugs (Moris et al. 2017; Kou et al. 2020; Li et al. 2020). However, currently, there are few effective anti-adhesion drugs.