THE DIFFERENT mechanisms of postoperative peritoneal adhesion formation have been elucidated. However, the prevention of these adhesions still presents a major problem. The methods that may be considered in prevention of postoperative adhesions may be classified into five different groups.
1. Peritonealization: covering all raw surfaces by peritoneum, omental, or amniotic membrane grafts.1,2
2. Mechanical separation of raw surfaces. This may be achieved in several ways.
(a) Activation of early peristalsis by pharmacological (prostigmin) or mechanical methods (heat, diathermia, etc).3,4
(b) Introduction into peritoneal cavity of substances that will keep operative surfaces separated. This includes the introduction of isotonic solutions, amniotic fluid, macromolecular dextran, lubricants like polyvinylpyrolidone, and others1,5-10 (an unpublished data).
3. Anticoagulants applied locally.11
4. Fibrinolytic or proteolytic enzymes like streptokinase and streptodornase.11-14
5. Inhibition of connective tissue formation by corticoids applied locally or given systemically.14,15
Some of these methods have proved