The injured peritoneum: Consequences of surgery on an organ

Abstract

Surgical trauma to the peritoneum is inevitable during abdominal surgery, whether performed by laparoscopy or laparotomy. Obviously, entering the abdominal cavity is an essential prerequisite in order to be able to perform any kind of surgical intervention intra-abdominally. However, among surgeons there is only little awareness of the consequences of this essential part of an abdominal procedure. Postoperative adhesions, responsible for an increased risk of small bowel obstruction, infertility, chronic abdominal pain and considerable difficulties at re-operations, are often taken for granted whereas attempts to prevent them are not being considered. In case of oncological abdominal surgery the traumatised peritoneum may facilitate outgrowth of spilled tumour cells, inducing peritoneal carcinomatosis and hence a worsened outcome for the patient. Increasing the awareness of sequelae of surgical trauma to the peritoneum hopefully leads to a reduction ofthe amount of peritoneal damage during surgery and a decrease in postoperative morbidity for the patient.