Abstract
Post-surgical adhesions are internal scar tissue and a major health and economic burden. Adhesions affect and involve the peritoneal lining of the abdominal cavity, which consists of a continuous mesothelial covering of the cavity wall and majority of internal organs. Our understanding of the full pathophysiology of adhesion formation is limited by the fact that the mechanisms regulating normal serosal repair and regeneration of the mesothelial layer are still being elucidated. Emerging evidence suggests that mesothelial cells do not simply form a passive barrier but perform a wide range of important regulatory functions including maintaining a healthy peritoneal homeostasis as well as orchestrating events leading to normal repair or pathological outcomes following injury. Here, we summarise recent advances in our understanding of serosal repair and adhesion formation with an emphasis on molecular mechanisms and novel gene expression signatures associated with these processes. We discuss changes in mesothelial biomolecular marker expression during peritoneal development, which may help, in part, to explain findings in adults from lineage tracing studies using experimental adhesion models. Lastly, we highlight examples of where local tissue specialisation may determine a particular response of peritoneal cells to injury.
Highlights
Adhesions are bands of scar tissue connecting opposing organs together or to the inner abdominal cavity wall
Genetic lineage tracing in the adult mouse have shown that in normal tissue homeostasis and when compared to the embryo, Wilms’ tumour protein 1 (WT1)-expressing mesothelial cells do not contribute to the mesenchymal cell types in the lung, heart, liver, and intestine [109,110]
To better understand the key cellular and molecular mechanisms that contribute to adhesion formation, there needs to be a clearer knowledge of the contribution and source of peritoneal cells in development, homeostasis, and repair
Summary
Adhesions are bands of scar tissue connecting opposing organs together or to the inner abdominal cavity wall. Many patients will be clinically asymptomatic post-surgery; others will experience high morbidity, significant health issues, and possible hospitalisation for adhesion-related complications including bowel obstruction, female infertility, and chronic pelvic pain as well as difficulties with any repeat surgery [4]. Group performed the first large retrospective cohort study of over 21,000 patients who underwent open abdominal or pelvic surgery [7] They found that 5.7% of re-admissions were directly related to adhesions with nearly a quarter of these being in the first year after surgery [7]. As the majority of adhesions occur post-operatively, the consequences of surgically related injury will be the emphasis of this review; there is likely overlap with other damage inducing scenarios involving chronic inflammation, infection, peritoneal dialysis, and ischaemia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
