Factors influencing the incidence of postoperative abdominal adhesions: an experimental study.

Adult male Wistar rats were anesthetized with intraperitoneal sodium pentobarbitone, and laparotomies were performed to determine the role of common surgical practices in the etiology of intestinal adhesions. Rats were divided into 4 groups (Group 1, control; Group 2, small intestine delivered from the abdomen and placed on the skin without protection; Group 3, small intestine kept moist by covering with saline-soaked gauze; and Group 4, small intestine placed in plastic bag). At the end of 1 hour, all intestine were replaced in the peritoneal cavity, and rats were sacrificed 1 week later and examined for peritoneal adhesion formaiton. In general, the incidence of fibrinous adhesions was increased by removing the intestines from the peritoneal cavity. Groups 3 and 4 showed no lessening of adhesion formation with their various treatments. Incidence of plastic adhesions in laparotomy wounds closed without suturing was lower than when sutures were used. No difference was noted among types of suture material. The phenomenon of suture-induced adhestions seems a result of a reduction of fibrinolysin activity of serosa cells at the site, and the presence of the suture material allows the adhesion a harbor to establish itself in.