ABSTRACT
Whether induced by infection, inflammation, ischemia, and/or surgical injury, peritoneal
adhesions are the leading cause of pelvic pain, bowel obstruction, and infertility.
Although some patients develop limited scar tissues, others for unknown reasons develop
severe adhesions from seemingly equal procedures. Additionally in the same patient,
adhesions develop at one surgical site but not in another. The mechanisms underlying
the predisposition to form scars as well as their site specificity are unknown. Because
a large number of intraperitoneal surgical procedures are performed each day, many
patients are at risk of developing postoperative adhesions. As such, understanding
the nature of molecular events and their mechanisms of action is essential, and in
the absence of such information, attempts to prevent patients from developing adhesions
will remain an empirical process. An unprecedented advancement in surgical techniques
have resulted in minimizing peritoneal tissue injury that cause adhesion formation.
Increased understanding of the cellular and molecular events that lead to scar tissue
formation has also led to the identification of many biologically active molecules
with the potential of regulating inflammatory and immune responses, angiogenesis,
and tissue remodeling, events that are central to normal peritoneal wound healing
and adhesion formation. This article attempts to highlight some of the key molecules
(i.e., the transforming growth factor family and its regulatory mechanisms) that are
recognized to regulate peritoneal wound repair and adhesion formation. Such understanding
of peritoneal biology not only will assist us to better manage patients with adhesions
but also will assist those with endometriosis and malignant diseases that affect the
peritoneal cavity.
KEYWORDS
Peritoneum - wound repair - adhesions - growth factors - cytokines - chemokines -
proteases - clinical - molecular
REFERENCES
Prevention of Adhesion Development . In: Sutton C, Diamond MP Endoscopic Surgery for Gynecologists, 2nd ed. London, United
Kingdom; W.B. Saunders 1994: 398-406 Wound repair. Overview and general consideration . In: Clark RAF The Molecular Biology of Wound Repair, 2nd ed. New York, NY; Plenum
Press 1996: 3-50
cheginin@obgyn.ufl.edu
