Title: Pathophysiology of peritoneal adhesion formation
- Sergiusz Durowicz, Ireneusz Kozicki
- Review articles
- Polish Gastroenterology
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- postoperative intra-abdominal adhesions, peritoneal healing, adhesion formation, growth factors
The processes of normal peritoneal tissue repair and fibrous adhesion formation are inseparably connected. In this article, basic knowledge concerning the peritoneum and adhesions is presented. The processes occurring in the peritoneal cavity following trauma and leading to tissue healing or adhesion formation are also described. Adhesions were traditionally considered nonfunctional fibrous tissue. Closer studies showed that these structures are highly cellular, innervated, and vascularized. Two distinct features of the peritoneal surface play a key role in adhesion formation: its fragility and its constant readiness for re-epithelialization. Growth factors and cytokines, such as transforming growth factor-(5, epidermal growth factor, fibroblast growth factor, vascular endothelial growth factor, and many others, play crucial roles in the healing cascade. These agents influence many different processes taking place in the peritoneal cavity, for example changes in the mobilization of leukocyte subsets.The most important natural protection against adhesion formation is the fibrinolytic system. Tissue oxygen saturation in the peritoneal cavity following surgery is significantly reduced, which in turn causes depression of fibrinolytic system activity.