The formation of coalescing peritoneal adhesions requires injury to both contacting peritoneal surfaces.

OBJECTIVE: To determine whether surgical trauma to one or both contacting peritoneal surfaces is necessary to cause coalescing adhesions.
SETTING: Research laboratory.
DESIGN: The abdominal wall peritoneum and one or both contacting medial peritoneal surfaces of surgically approximated uterine horns in mice were injured by electrocautery, cutting, scratching, or scraping. Adhesion formation was assessed visually and histologically 3 and 7 days later.
RESULTS: Regardless of the type of peritoneal injury, few adhesions resulted when only a single injury was made to the abdominal wall (< or = 6%) or to one uterine horn (< or = 13%). When both opposing uterine surfaces were injured, however, adhesions formed at 57% of the sites after electrocautery, 100% after cutting, 100% after scratching, but 0% after scraping. When previously created uterine adhesions were lysed, they reformed at 15 of 15 sites with and 12 of 13 (92%) sites without electrocautery for hemostasis at the time of lysis.
CONCLUSIONS: In this murine model, the development of postsurgical adhesions required surgical trauma to both contacting peritoneal sites, regardless of the type of injury, the mobility of the opposing peritoneal surfaces or whether hemostasis was achieved. The clinical implications are that more attention needs to be focused on protecting contacting normal peritoneal surfaces from inadvertent injury during surgery and that different therapeutic strategies may be required for prevention of adhesion formation and reformation because of the high probability of contact between injured peritoneal surfaces with the latter.