Int J Biol Sci 2021; 17(1):298-306. doi:10.7150/ijbs.54403 This issue


A review of physiological and cellular mechanisms underlying fibrotic postoperative adhesion

Qiongyuan Hu, Xuefeng Xia, Xing Kang, Peng Song, Zhijian Liu, Meng Wang, Xiaofeng Lu, Wenxian Guan, Song Liu

Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School.

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Hu Q, Xia X, Kang X, Song P, Liu Z, Wang M, Guan W, Liu S. A review of physiological and cellular mechanisms underlying fibrotic postoperative adhesion. Int J Biol Sci 2021; 17(1):298-306. doi:10.7150/ijbs.54403. Available from

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Graphic abstract

Postoperative adhesions (PA) are fibrotic tissues that are the most common driver of long-term morbidity after abdominal and pelvic surgery. The optimal drug or material to prevent adhesion formation has not yet been discovered. Comprehensive understanding of cellular and molecular mechanisms of adhesion process stimulates the design of future anti-adhesive strategies. Recently, disruption of peritoneal mesothelial cells were suggested as the 'motor' of PA formation, followed by a cascade of events (coagulation, inflammation, fibrinolysis) and influx of various immune cells, ultimately leading to a fibrous exudate. We showed that a variety of immune cells were recruited into adhesive peritoneal tissues in patients with small bowel obstruction caused by PA. The interactions among various types of immune cells contribute to PA development following peritoneal trauma. Our review focuses on the specific role of different immune cells in cellular and humoral mechanisms underpinning adhesion development.

Keywords: adhesion formation, mesothelial cells, fibrosis, immune response