Peritoneal adhesions after laparoscopic gastrointestinal surgery

Table 1 Adverse factors causing peritoneal adhesions and proposed preventive factors

Adverse factors	Proposed preventive factors
Surgical trauma	Minimal incisions (laparoscopy)
Infections	Minimal infection risk
Mesothelial defects	Minimal tissue handling (good surgery)
Increased vessel permeability	Corticosteroids and antihistamines
Inflammatory exudate	Corticosteroids and NSAIDs
Blood	Achieve hemostasis (good surgery)
Fibrin mass/fibrin bands	Fibrinolytic agents
Ischemia	Maintenance of vascularity (good surgery)
Thermal injury	Avoidance of thermal injury (good surgery)
Foreign bodies (starch powder)	Good surgery/laparoscopy (starch-free gloves)
Desiccation	Moistening of tissues (irrigation/humidified pneumoperitoneum)
Inflammation	Corticosteroids and NSAIDs/“peritoneum-friendly” pneumoperitoneum
Over-expression of PAI-1 and PAI-2	Reduction of inflammation/“peritoneum-friendly” pneumoperitoneum
Suppression of fibrinolytic activity	Fibrinolytic agents/“peritoneum-friendly” pneumoperitoneum
High-pressure CO2 pneumoperitoneum	Reduction of pneumoperitoneum pressure
Long-duration CO2 pneumoperitoneum	Rapid surgery
High intra-peritoneal temperature	Cooling of the peritoneal cavity
100% CO2 pneumoperitoneum	Lower CO2 concentration (gas mixture)

NSAID: Non-steroidal anti-inflammatory drug; PAI: Plasminogen activator inhibitor.