The effect of fibrinolysin and heparin on the formation of peritoneal adhesions.

Abstract

T he problem of postoperative peritoneal adhesions is still unsolved, despite many advances in clinical surgery. In one postmortem study,s 90 per cent of patients with previous abdominal surgery were found to have peritoneal adhesions. Though most adhesions do not result in clinical morbidity, their role as a cause of small bowel obstruction (about 30 per cent)20 is well recognized. In those unfortunate patients who have multiple episodes of mechanical ileus and are subjected to repeated lyses of recurrent adhesions, surgery often seems to aggravate rather than alleviate the disease. Many methods of treatment based on varied concepts of the pathogenesis of adhesion formation have been investigated in experimental animals and in patients. Most have been directed at inhibiting or counteracting some phase in the organization of adhesions. These include the use of (1) membranes applied to abdominal viscera, (2) the intraperitoneal instillation of gases, lubricants, solutions of varying tonicity, and peptones, (3) methods to enhance intestinal peristalsis, (4) the instillation of enzymes such as pepsin, trypsin, and papain, and, finally, (5) amniotic fluid