What are postsurgical peritoneal adhesions?

Postsurgical peritoneal adhesions are fibrous bands of scar tissue that form between abdominal organs and tissues following surgery or inflammation in the peritoneal cavity. The peritoneum is a thin membrane that lines the abdominal cavity and covers the abdominal organs. When the peritoneum is damaged or inflamed, such as during surgery or as a result of infection or trauma, it can trigger a healing response that involves the formation of scar tissue.


Peritoneal adhesions can vary in size, shape, and extent and may involve one or multiple abdominal organs. They can be filmy and delicate or dense and fibrous, and they can form between any combination of abdominal organs, such as the intestines, stomach, liver, spleen, and abdominal wall.


What is the relationship between postsurgical peritoneal adhesions and oxidative stress?

The relationship between postsurgical peritoneal adhesions and oxidative stress is an area of emerging research. Peritoneal adhesions are fibrous bands of scar tissue that form between abdominal organs and tissues following surgery or inflammation. These adhesions can cause organs to become stuck together, leading to complications such as bowel obstruction, chronic pain, and infertility.


  • Oxidative stress, characterized by an imbalance between the production of reactive oxygen species (ROS) and the body’s antioxidant defenses, has been implicated in the pathophysiology of peritoneal adhesions. Several factors related to surgery and tissue injury can contribute to oxidative stress, which may in turn promote the formation and persistence of peritoneal adhesions:


  • Ischemia-Reperfusion Injury: During surgery, temporary interruption of blood flow to abdominal tissues followed by restoration of blood flow (ischemia-reperfusion injury) can lead to the generation of ROS and oxidative stress. Ischemia-reperfusion injury contributes to tissue damage and inflammation, which are key factors in the development of peritoneal adhesions.


  • Inflammatory Response: Surgery triggers an inflammatory response in the peritoneal cavity, characterized by the release of pro-inflammatory cytokines and activation of immune cells. Inflammatory processes can generate ROS and promote oxidative stress, which may exacerbate tissue injury and contribute to adhesion formation.


  • Tissue Trauma: Surgical manipulation and tissue injury during surgery can cause oxidative damage to peritoneal tissues, leading to the release of inflammatory mediators and the activation of fibroblasts, which are involved in the formation of scar tissue and adhesions.


  • Hypoxia and Hypoxia-Inducible Factors: Hypoxia (low oxygen levels) in the peritoneal cavity, resulting from tissue injury and inflammation, can induce the expression of hypoxia-inducible factors (HIFs), which regulate cellular responses to hypoxia. HIFs have been implicated in the pathogenesis of peritoneal adhesions and may promote fibrosis and adhesion formation through mechanisms involving oxidative stress.


  • Extracellular Matrix Remodeling: Oxidative stress can promote the remodeling of the extracellular matrix, which provides structural support to tissues and plays a crucial role in wound healing and tissue repair. Dysregulated extracellular matrix remodeling may contribute to aberrant scar formation and adhesion formation.


While the precise mechanisms linking oxidative stress to peritoneal adhesions are not fully understood, oxidative damage to peritoneal tissues and dysregulation of inflammatory and fibrotic pathways are believed to play a role.