TY - JOUR
AU - Darmas, B
AB - Sir I read with great interest the leading article by Harris and Topley. I would like to mention two points with regard to this article. First, the authors suggest that techniques to reduce intra-abdominal adhesion formation should be aimed towards minimisation of mesothelial injury or careful repair of any peritoneal defect. The second part of the statement is contrary to the experimental work of Ellis1 and Raftery2 who demonstrated that adhesions did not form between the intra-abdominal wall denuded of peritoneum, but did form when the peritoneal defect was repaired using sutures. This finding suggested that the formation of adhesions occurred in response to ischaemia resulting from strangulation of the peritoneum by sutures. Ellis1 postulated that adhesions act as vascularised grafts in order to maintain tissue perfusion to ischaemic organs. The presence of vessels in adhesions is well documented1,3. Secondly, although in principle I do agree with the authors' conclusion that so far no single anti-adhesion product has gained widespread use in general surgery, it is worth mentioning another product called Interceed. This is an oxidised, regenerated cellulose membrane which has gained some popularity in gynaecological surgery. The anti-adhesion formation properties of this membrane have been tested in two randomized controlled trials (RCT)4,5. However, these RCTs suffered from the common methodological limitations such as use of surrogate outcomes and an unvalidated subjective adhesion grading system and short follow-up. Although the leading article is not a comprehensive review of all anti-adhesion methods, Interceed is an FDA-licensed product and should have been mentioned. References 1 Ellis H . The aetiology of postoperative abdominal adhesions Br J Surg 1962 ; 50 : 10 – 16 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Raftery AT . Regeneration of parietal and visceral peritoneum. A light microscopical study . Br J Surg 1973 ; 60 : 293 – 299 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Buckman RF , Woods M, Sargent L, Gervin AS. A unifying pathogenetic mechanism in the etiology of intraperitoneal adhesions . J Surg Res 1976 ; 20 : 1 – 5 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Interceed(TC7) Adhesion Barrier Study Group . Prevention of postsurgical adhesions by Interceed (TC7), absorbable adhesion barrier: a prospective, randomised multicenter clinical study . Fertil Steril 1989 ; 51 : 933 – 938 . Crossref Search ADS PubMed WorldCat 5 Azziz R , Interceed (TC7) Adhesion Barrier Study Group II . Microsurgery alone or with Interceed absorbable adhesion barrier for pelvic sidewall adhesion reformation . Surg Gynecol Obstet 1993 ; 177 : 135 – 139 . Google Scholar PubMed OpenURL Placeholder Text WorldCat Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Peritoneal adhesions (Br J Surg 2008; 95: 271–272)
JO - British Journal of Surgery
DO - 10.1002/bjs.6342
DA - 2008-07-11
UR - https://www.deepdyve.com/lp/oxford-university-press/peritoneal-adhesions-br-j-surg-2008-95-271-272-a7juRK5pvQ
SP - 1071
EP - 1072
VL - 95
IS - 8
DP - DeepDyve
ER -