Intra-abdominal adhesions: pathogenesis, consequences, prevention

Objective. To systematize data and analyze pathogenetic mechanisms of formation of intra-abdominal adhesions, possible consequences of formation of intra-abdominal adhesions, such as acute small bowel obstruction and female infertility, as well as the methodology of preventative measures for occurrence of peritoneal adhesions.

Materials and methods. A non-systematic analysis of scientific publications in PubMed, EMBASE, Web of Science, Google Scholar, Elibrary, and CyberLeninka for the period 1989–2025 was conducted, describing pathogenetic aspects of the adhesive process of the peritoneum; the role of adhesions in the development of conditions such as acute small bowel obstruction and female infertility, as well as options for preventing these conditions, were reviewed. A total of 46 original publications were selected.

Results. A key factor in the pathogenesis of peritoneal adhesions is a disruption of mesothelisation processes resulting from an imbalance of the peritoneal fibrinolytic system. This imbalance manifests itself with the inhibition of fibrinolysis as a result of a number of factors. These include extensive damage to the peritoneum, insufficient hemostasis, and intra-abdominal infection. The adhesive process of the peritoneum is the leading cause of the acute small bowel obstruction, accounting for 56% of cases. The adhesive process of the pelvic peritoneum occupies one of the leading positions in the etiology of female infertility. Up to 23% of women undergo treatment for infertility after abdominal surgery. Modification of surgical techniques does not significantly reduce adhesiogenesis. The most effective method of prevention of adhesive peritoneal disease is the use of anti-adhesion barriers.

Conclusion. Prevention of the adhesive process is a critical area of healthcare, reducing the frequency of complications and mortality in conditions associated with the formation of adhesions. Development of new anti-adhesion barriers based on the pathogenetic mechanisms of adhesion formation is a promising direction in the prevention of the adhesive process.

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