ADHESIVE DISEASE OF THE ABDOMINAL CAVITY: ETIOMORPHOPATHOGENESIS, CLINIC, DIAGNOSIS, TREATMENT AND PREVENTION AT THE PRESENT STAGE

Abstract

In surgery of the gastrointestinal tract, peritoneal adhesions are detected in 80-90% of cases, including open surgical interventions, abdominal adhesions occur in 70-90% of patients, with laparoscopic – in 24-35% of patients. The number of deaths in adhesive disease ranges from 14 to 52%, and in patients with concomitant pathology, whose age exceeds sixty years, reaches 68%. The main etiological factors of the formation of adhesions are mechanical, chemical, physical and infectious effects. The pathogenesis of the formation of adhesions includes three processes: inhibition of fibrinolytic and extracellular matrix degradation systems; inflammatory reaction with cytokine production, mainly TGF-β1; tissue hypoxia as a result of interruption of blood supply to mesothelial cells and submesothelial fibroblasts. The clinical picture of SBBP, as a rule, is characterized by dyspeptic disorders in the early stages, and is accompanied by symptoms of intestinal obstruction in the advanced ones. The "gold standard". Treatment of adhesive disease can be carried out using conservative therapy or surgical intervention. To date, prevention is the most preferred method to prevent the consequences of the development of adhesive disease. Despite the improvement of surgical techniques, the development of new approaches to treatment and diagnosis, adhesions remain an inevitable consequence of intra-abdominal operations. Understanding the pathogenesis of the formation of the adhesive process and adhesion, the possibility of their transformation, especially at the cellular and molecular level, can help in the further development of more effective methods of treatment and prevention of SBP.