Factors Influencing the Incidence of Postoperative Abdominal Adhesions: An Experimental Study

Abstract

The incidence of fibrinous intestinal adhesions following laparotomy in rats was increased by removing the intestines from the peritoneal cavity. This incidence was not significantly influenced by placing the intestines either in sterile plastic bags or in gauze swabs soaked in normal saline. The incidence of plastic adhesions in laparotomy wounds closed without suturing the peritoneal layer was less than when this was sutured. The use of non‐absorbable silk sutures when compared with that of absorbable catgut made no difference to this incidence, nor did the use of interrupted sutures as opposed to continuous.It is postulated that the presence of sutures in the peritoneal layer would cause a prolonged defect in serosal cell cover which could result in a reduction of fibrinolysin activity of serosa cells at that site. The suture material would also offer a site of protection of an immature fibrinous adhesion from adjacent serosa cell fibrinolytic activity. Such conditions would facilitate organization of an otherwise temporary and reabsorbable immature adhesion into a permanent mature fibrous structure, as has been observed in long‐term studies following the use of non‐absorbable suture material or talcum powder in the peritoneal cavity.