الفهرس 
Anatomy and physiology of peritoneumOnly 14 pages are availabe for public view
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Abstract
The formation of peritoneal adhesions continues to plague patients, surgeons and society. Although research in this area is ongoing, there is currently no method that is 100% effective in adhesion prevention, nor is there any way to permanently remove them once they have formed. As our understanding of the specific mechanisms involved in peritoneal repair evolves, it seems likely that specific targets for adhesion prevention will be identified and evaluated. The bioresorbable membrane Seprafilm is currently the most effective adjuvant to decrease adhesion formation, and this barrier may be considered for use in patients in whom the formation of adhesions postoperatively is particularly undesirable. The long-term outcomes with this agent remain unknown. Newer products are being developed that seem promising, but their efficacy has yet to be proven in clinical trials. Until then, surgeons should continue to be meticulous in their operative technique and should seek to minimize injury to the peritoneal surface.
As laparoscopic experience has increased and advances with instruments have been made, laparoscopic treatment of SBO has become possible. In fact, in experienced hands, laparoscopy is a viable alternative to formal laparotomy. Laparoscopic management of SBO appears to offer the advantage of decreased overall morbidity, earlier return of bowel function, decreased length of hospital stay, and faster return of full activity. Developing selection criteria for laparoscopic management of ASBO may be helpful. In terms of technique, patient positioning is very important for success. Bowel should be examined for perforation and signs of ischemia. One of the most dreaded complications in laparoscopic management of SBO is missed enterotomy. The risk of bowel injury can be diminished by following good surgical technique.
Energy-based devices to divide adhesions should be avoided and there should be a low threshold for conversion. Conversion should not be viewed as a sign of failure; instead, it represents good clinical judgment