Pharmacologic inhibition of adhesion formation and peritoneal tissue-type plasminogen activator activity

Intraperitoneal adhesions remain a costly, long-term sequela of abdominal surgery. They cause significant postoperative morbidity and difficult reoperative surgery. Although adhesions have been recognized for more than 250 years, a uniformly effective method of adhesion prevention does not exist. In recent years, research has become more focused on understanding the biochemical and cellular processes involved in adhesion formation-a necessary step in the development of safe and effective means of adhesion prevention. Studies suggest that events critical to adhesion outcome begin within hours of an abdominal operation with the balance between fibrin deposition and degradation being of central importance. A pharmacologic agent administered at the time of surgery that could tip the fibrinolytic balance in favor of fibrin degradation without interfering with postoperative wound healing would be an ideal candidate in the prevention of adhesion formation. Further research into the molecular and cellular events that underlie adhesion formation is essential and undoubtedly will lead to successful adhesion prevention.