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September 1965

Peritoneal AdhesionsExperimental Use of Fibrinolysin To Prevent Reformation

Author Affiliations

From the Department of Surgery, Faculty of Medicine, University of British Columbia.

Arch Surg. 1965;91(3):413-418. doi:10.1001/archsurg.1965.01320150043006

PERITONEAL adhesions continue to be a serious cause of morbidity and mortality after abdominal operations and peritonitis in both children and adults. The methods commonly used in their control, though perhaps more expertly applied nowadays, have not changed since the beginnings of abdominal surgery. These methods, of which only the first three are in general use, may be grouped as follows:7,3

Avoidance of Trauma to the Peritoneum at Operation.  —This is still the best way to avoid adhesions. All kinds and causes of trauma are important: (1) mechanical (gauze, instruments), (2) ischemic; suturing peritoneum under tension may cause more trouble than leaving defects open,8 (3) chemical (powder from rubber gloves, intraperitoneal foreign bodies, bowel content), (4) drying of peritoneum including thermal trauma from hot lights, (5) bacterial contamination, (6) intraperitoneal bleeding.

Splinting of Bowel in Non-Obstructed Position.  —This does not avoid adhesions, but may prevent their causing obstruction.

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