2adhesi Intraperitoneal Post Op
2adhesi Intraperitoneal Post Op
Adhesi intraperitoneal :
perlengketan fibrosa yg abnormal di antara permukaan
peritoneum yg berdekatan, baik antara peritoneum visceral
maupun antara peritoneum visceral dg parietal
Adhesi intraperitoneal pasca operasi
Sering dijumpai
morbiditas & mortalitas ↑
Trauma operasi
Iskemia jaringan
Infeksi, reaksi alergi dan darah
Benda asing iritatif
Klasifikasi Ellis :
1. Pencegahan deposisi dari fibrin
Antikoagulan :
- heparin, aprotinin
2. Menghilangkan eksudat fibrin dari rongga
peritoneum
Agen-agen fibrinolitik :
- fibrinolisin, streptokinase, urokinase, hyaluronidase,
kimotripsin, tripsin, pepsin dan plasminogen
activator
3. Pencegahan proliferasi fibroblas
Agen anti inlamasi :
- kortikosteroid, NSAID, antihistamin, progesteron,
Ca blocker dan kolkisin
4. Pemisahan mekanik
Larutan makromolekul :
- kristaloid, 32% dextran 70, asam hyaluronat, karboksimetilselulosa
( crystalloids such as normal saline and Ringer’s lactate were used to produce
a ‘hydroflotation’ effect by instilling 500ml to 3 litres of fluid into the peritoneal
cavity at the end of surgery in an attempt to prevent adhesion formation )
Sarung tangan bebas bedak
Lavase peritoneum
Penempatan omentum di bawah penutupan luka