Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.222
Peer-review started: July 8, 2015
First decision: September 8, 2015
Revised: December 26, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 27, 2016
Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients.
Core tip: Adhesive disease is a consequence of all intra-peritoneal surgeries. We decided to carry out a systematic review about the adhesive small bowel obstruction because it is still difficult to make differential diagnosis and to understand the right time to operate and which surgical technique to perform. Besides there is a way to prevent major adhesive disease: "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss all current knowledge in this field.