Adhesion formation of the parietal and visceral peritoneum: an explanation for the controversy on the use of autologous and alloplastic barriers?
Wallwiener D. Meyer A. Bastert G.
Department of Obstetrics and Gynecology, University of Heidelberg, Germany.
OBJECTIVE: To compare formation of adhesions after injury to both parietal and visceral peritoneum and to determine the benefit of autologous transplants and alloplastic barriers in adhesion prevention. DESIGN: Experimental prospective animal study and prospective randomized clinical study. SETTING: An academic research environment. PATIENT(S): Forty women undergoing laparoscopy for endometriosis treatment. INTERVENTION(S): In 60 rats, either the visceral or parietal peritoneum was injured and covered with autologous peritoneal transplants in half of the animals. The formation of adhesions was assessed 21 days postoperatively. In women, adhesions were evaluated 3 months after surgery with or without placement of alloplastic barriers on visceral lesions. MAIN OUTCOME MEASURE(S): Adhesions evaluated according to a scoring system. RESULT(S): Adhesions after injury of the visceral peritoneum in rats were significantly more severe than those from the parietal peritoneum. Autologous peritoneal transplants led to fewer adhesions especially after serosal injuries. Female volunteers treated with alloplastic barrier material showed less severe adhesions than the control group. CONCLUSION(S): The present data indicate that the potential to form adhesions is significantly higher in visceral than in parietal peritoneal lesions. The development of adhesions after injury to the visceral peritoneum could be reduced by a synthetic barrier material.
Pelvic adhesions contain sex steroid receptors and produce angiogenesis growth factors.
Wiczyk HP. Grow DR. Adams LA. O'Shea DL. Reece MT.
Department of Obstetrics and Gynecology, Tufts University School of Medicine, Springfield, Massachusetts, USA.
OBJECTIVE: To evaluate female pelvic adhesion tissue for the presence of estrogen receptor (ER), progesterone receptor (PR), basic fibroblastic growth factor (basic-FGF), and vascular endothelial growth factor (VEGF). DESIGN: Descriptive study. SETTING: Patients at a tertiary medical center. PATIENTS: Female reproductive age patients undergoing gynecologic surgery who were not receiving hormonal therapy. INTERVENTIONS: Female reproductive tract peritoneal adhesion tissue was excised, frozen, and sent for immunohistologic evaluation. MAIN OUTCOME MEASURE: Presence of ER, PR, basic-FGF, and VEGF in adhesion tissue. RESULTS: Nineteen of 19 specimens were positive for PR; 16 of 19 specimens were positive for ER, which was present in a variety of the different cell types constituting adhesion. Vascular endothelial growth factor and basic-FGF were detected in endothelial cells of blood vessels supplying this tissue as well as in mesothelial cells. CONCLUSION: Adhesion tissue contains ER, PR, and growth factors that may be important in the genesis of the permanent fibrovascular bands between pelvic organs. This supports the theoretical possibility of hormonal manipulation of these tissues to negatively influence postoperative pelvic adhesion formation.