Foreign material in adhesion formation after abdominal surgery. A clinical and experimental study.

Abstract

Clinical and experimental studies are presented documenting the occurrence of foreign body reactions and their effects on adhesion formation after abdominal surgery; results reported are gleaned from 309 patients and 49 experimental animals. Clinically 61% of cases developed foreign body reactions postoperatively. Age and sex of patient and previous intraabdominal surgery did not affect the frequency. A correlation was observed between the occurrence of foreign body reactions and adhesions; the frequency of reactions increased with an increasing amount of adhesions. Foreign body granulomas to talc were the most frequently identified (31% of patients). Gauze lint-induced lesions occurred in 16%; starch granulomas were observed only twice. Foreign body reactions caused by mixed foreign material were relatively common (11%). The mechanism of adhesion formation was investigated in experimental animals. It was found that foreign matter introduced into the abdomen accumulated in traumatized areas. Adhesions developed in these areas and persisted; occurrence of permanent adhesions seems dependent on whether the resolution process is impeded by foreign matter. From studies of the vascular pattern of experimental adhesions it was concluded that the omentum is the only intraabdominal vascular source of importance to tranumatized areas of the peritoneum.