Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
505
ORCID: 0009-0006-5966-9149
UDK: 616.341-007.272-02:073:089
FORECASTING AND PREVENTION OF SPIKE FORMATION IN ACUTE
INTESTINAL OBSTRUCTION
Sapaev Akbar Dilshadovich
,
PhD in Medicine, Assistant Professor
Assistant of the Department of Surgical Diseases,
Tashkent Pediatric Medical Institute.
Email:
Okhunov Alisher Oripovich
,
Doctor of Medical Sciences, Professor
Head of the Department of General and Pediatric Surgery,
Tashkent Medical Academy.
Email: general-surgery@mail.ru
Sapaev Dilshad Aminovich
,
Doctor of Medical Sciences, Head of the Department
Head of the Department of Surgical Diseases in Family Medicine,
Urgench Branch of Tashkent Medical Academy.
Email: dilshad.sapayev@mail.ru
Masharipov Khurshidbek Shomurat ugli
,
Student
2nd-year student of the Faculty of General Medicine,
Urgench Branch of Tashkent Medical Academy.
Email: khurshidbekmasharifov5@gmail.com
ABSTRACT:
This article is dedicated to studying the mechanisms of adhesion formation in
acute intestinal obstruction (AIO) and developing effective methods for their forecasting and
prevention. The study involved a comprehensive analysis of clinical data from 300 patients,
experimental work using anti-adhesion barrier materials, and molecular-biological research. Key
risk factors for adhesion formation were identified, including the duration of surgery lasting
more than 90 minutes, the presence of inflammatory diseases of the abdominal cavity, and the
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
506
use of open surgical methods. The analysis of molecular markers such as CRP, IL-6, TGF-β, as
well as genetic polymorphisms of COL1A1 and COL3A1, allowed for the identification of risk
groups and the proposal of a personalized approach to prevention. The results showed that the
use of anti-adhesion barrier materials based on hyaluronic acid reduced the incidence of adhesion
formation from 62% to 18%. A comprehensive prevention algorithm was developed, including
preoperative testing, minimizing surgical trauma, using modern materials, and implementing
early rehabilitation programs. The introduction of this algorithm led to a reduction in the
incidence of adhesions to 22%, a decrease in repeated hospitalizations to 10%, and a reduction in
the average length of hospitalization from 14 to 9 days. The results confirm the effectiveness of
the comprehensive approach and justify the need for its implementation in clinical practice to
improve treatment outcomes and enhance the quality of life for patients
Keywords:
acute intestinal obstruction, adhesion formation, prevention, anti-adhesion
materials, molecular markers, laparoscopy, forecasting, early rehabilitation, genetic screening,
inflammatory markers.
INTRODUCTION
Acute intestinal obstruction (AIO) is one of the most dangerous and complex surgical
pathologies, requiring urgent intervention. Adhesion formation is the leading etiological factor,
occurring in 60-70% of cases of chronic intestinal obstruction and complicating the
postoperative period. According to the World Health Organization (WHO), more than 4 million
people suffer from adhesive disease annually, and up to 70% of all cases of acute intestinal
obstruction recurrence are caused by the adhesive process. In developed countries, the treatment
of complications related to adhesions costs about 2 billion dollars annually, which indicates
significant economic losses. An analysis of clinical data in Uzbekistan shows that, of more than
15,000 cases of abdominal surgery annually, 40% of patients develop adhesions, leading to
chronic pain, impaired bowel function, and repeated hospitalizations. Particularly problematic
are cases of AIO in the working population, which exacerbates the socio-economic consequences
of the disease. Modern studies emphasize the need for early forecasting of adhesion risk, as this
significantly reduces recurrence rates and improves patients' quality of life. The most promising
preventive methods include the use of anti-adhesion barriers, minimally invasive surgical
techniques, as well as comprehensive drug therapy aimed at reducing inflammatory processes.
However, the implementation of these methods in clinical practice requires further scientific
substantiation and testing. The relevance of this topic is determined not only by the high
frequency of adhesion formation but also by the lack of universal preventive approaches, which
creates a need for the development of innovative methods for forecasting and prevention. The
aim of this study is to identify key risk factors, improve preventive methods, and implement new
technologies aimed at reducing the frequency of adhesion formation in acute intestinal
obstruction.
LITERATURE REVIEW
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
507
In a number of fundamental and clinical studies by foreign scientists (Ellis H., Menzies D.,
Holmdahl E., diZerega G.S., Kamel R., and others), it has been shown that adhesion formation is
a key factor in recurrent acute intestinal obstruction (AIO) in 60-70% of cases [1;2;3]. According
to T. Parker et al. (USA), the treatment of adhesive complications costs about 2 billion dollars
annually, and adhesions are responsible for 50-65% of repeated hospitalizations [4;5]. Wang et al.
(China) note that the risk of adhesion formation is particularly high in patients with immune
dysfunction and concomitant inflammatory diseases of the abdominal cavity [6]. In the studies
by Menzies D. and Kamel R., the molecular-biological aspects of adhesion formation are
highlighted: an increase in the levels of interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and
transforming growth factor-beta (TGF-β) contributes to the excessive production of fibroblasts
and enhanced collagen formation [7;8]. Holmdahl E. and colleagues have proven that the use of
anti-adhesion barrier systems (based on hyaluronic acid, carboxymethylcellulose, etc.) can
reduce the frequency of adhesion formation by 30-40% [9;10]. In the works of Ellis H. and
diZerega G.S., it is also noted that the preventive approach to adhesion formation, starting from
the preoperative stage, is the most promising. According to researchers, comprehensive therapy
(antibacterial, anti-inflammatory, immunostimulatory) and minimizing the trauma of the surgical
intervention (using laparoscopic technologies) are decisive in preventing adhesion formation
[11;12]. Modern foreign research (Parker T., Menzies D., Wang H., Kamel R.) actively
implements a multimodal approach: combining early diagnosis (ultrasound, CT, MRI), the use of
biomaterials (bio-barrier gels and films), as well as personalized treatment regimens based on the
genetic profile of the patient [15;16]. According to their data, this approach reduces recurrent
cases of AIO by almost two times and decreases the risk of postoperative complications by 25-
35% [17].
In scientific publications by Russian researchers (Ivanov A.I., Petrov V.S., Sidenko N.V.,
Grigoryev M.P., and others), adhesion formation in acute intestinal obstruction is considered one
of the main causes of mortality, which reaches 8-10% in some regions [18;19]. Petrov V.S. and
colleagues note that, in patients with postoperative adhesions, the likelihood of reoperation
within the first 3-5 years after the primary surgery increases to 40% [20]. Research by Ivanov
A.I. indicates the leading role of systemic inflammatory responses (elevated levels of C-reactive
protein, IL-1, IL-6) in the formation of dense adhesions, which may lead to severe forms of AIO
[21]. Grigoryev M.P. emphasizes the importance of strictly adhering to surgical technique, using
minimally invasive methods (laparoscopy), and proper postoperative rehabilitation to reduce
recurrence rates [22]. In the works of Ukrainian authors (Kovalenko A.V., Maksymchuk P.A.,
Doroshenko N.M., and others), it is noted that the main risk factors for adhesion formation are
repeated surgical interventions, a history of inflammatory diseases of the abdominal cavity, and
delayed medical consultation [23]. According to Doroshenko N.M., the use of modern barrier
technologies in planned surgeries reduces the risk of massive adhesion formation by 30% [9;19].
Moreover, new preventive methods are proposed, including carbotherapy, physiotherapeutic
procedures, and antibacterial protection, which significantly impact the reduction of
postoperative complications. Overall, studies in the CIS countries (Russia, Ukraine, Belarus, etc.)
emphasize the need for a comprehensive approach to the prevention of adhesions: combining
minimally invasive surgery, the use of anti-adhesion agents, early rehabilitation (fast-track
surgery), and taking into account the individual characteristics of the patient allows for a
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
508
significant reduction in the recurrence rates of AIO [5;10;13]. In Uzbekistan, the problem of
adhesion formation in acute intestinal obstruction is given serious attention by researchers such
as Saidov Z.A., Nazarov O.T., Norov B.K., Rakhmonov A.U., and others [1;6;16]. According to
Saidov Z.A., more than 15,000 cases of emergency surgeries on abdominal organs are recorded
annually in the republic, and in 40-45% of these cases, adhesions later form, leading to repeated
patient visits [2;17]. In his work, Nazarov O.T. emphasizes the importance of early diagnosis of
adhesions using ultrasound and tomography methods, as well as the use of laparoscopic control,
which enables the timely identification and dissection of thin adhesions before the development
of severe forms of AIO [7;18]. According to Norov B.K., this approach reduces the risk of
repeated hospitalizations by 25-30% [9;20]. Rakhmonov A.U. and colleagues are studying local
anti-adhesion drugs based on hyaluronic acid and chitosan, which are undergoing clinical trials
at several national centers (Tashkent, Fergana, Jizzakh). Preliminary results indicate that the use
of such barrier agents in combination with antibacterial and anti-inflammatory therapy
significantly reduces the likelihood of extensive adhesion formation [14;21]. Special attention is
given to the work of a group of scientists led by Saidov Z.A., studying genetic predispositions to
adhesion formation. Preliminary data suggest increased expression of several genes associated
with collagen formation (COL1A1, COL3A1) and inflammation (IL-6, TNF-α) in patients with
frequent recurrences of AIO [12;22]. These studies provide the opportunity for the prospective
development of a personalized approach to adhesion prevention, where genetic screening can be
used to predict the risk of complications and adjust patient management strategies [15;23]. Thus,
the analysis of scientific literature shows that the issue of adhesion formation in acute intestinal
obstruction remains highly relevant worldwide. Researchers from abroad, the CIS, and
Uzbekistan agree that effective prevention of AIO recurrences is impossible without a
comprehensive and personalized approach: the use of modern minimally invasive surgical
techniques, anti-adhesion barriers, immunomodulators, as well as careful pre- and postoperative
management of patients, with mandatory consideration of their individual characteristics. All of
this should be based on modern clinical and experimental data obtained through multicenter
studies.
METHODOLOGY OF THE STUDY
The methodological approach to researching the problem of predicting and preventing adhesion
formation in acute intestinal obstruction (AIO) is based on the comprehensive application of
clinical, experimental, and analytical methods. The study was conducted at the specialized
surgical department of the Tashkent State Medical Institute from 2020 to 2024, encompassing
300 patients diagnosed with acute intestinal obstruction. The primary focus was on developing
an algorithm for predicting and preventing adhesions, based on clinical and laboratory data. The
clinical part of the study included an analysis of medical histories of patients who underwent
surgical treatment for acute intestinal obstruction (AIO), with a focus on identifying risk factors
for adhesion formation, such as the type of surgical intervention, operation duration, presence of
concomitant inflammatory diseases, and postoperative period characteristics. Adhesion processes
were diagnosed using ultrasound methods, computed tomography, and laparoscopy. In the
experimental part, laboratory animals (rats and rabbits) were used to model adhesion formation
conditions. The application of various anti-adhesive barrier materials (hyaluronic acid,
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
509
carboxymethylcellulose) allowed for assessing their effectiveness in reducing the risk of
adhesion formation. Morphological evaluation of tissue samples included histological analysis of
adhesion density and structure, as well as the study of cellular activity. Immunological and
biochemical studies included determining levels of inflammation and adhesion formation
markers, such as C-reactive protein, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α),
and transforming growth factor-beta (TGF-β). The use of polymerase chain reaction (PCR) and
enzyme-linked immunosorbent assay (ELISA) enabled molecular analysis of genetic
predisposition to adhesions (COL1A1, COL3A1). For adhesion prevention, modern anti-
adhesive barrier materials, minimally invasive surgical techniques, anti-inflammatory and
antibacterial therapy were applied. Additionally, an early rehabilitation program was developed,
including patient mobilization in the postoperative period, physiotherapeutic procedures, and
nutritional support. Data analysis was carried out using statistical processing methods, including
correlation analysis, multivariate regression analysis, and predictive modeling. This allowed for
identifying key risk factors and assessing the effectiveness of the proposed preventive measures.
All stages of the study were conducted in compliance with ethical standards approved by the
local ethics committee.
RESEARCH RESULTS
As part of the study, a comprehensive analysis of clinical, immunological, biochemical, and
experimental data was conducted, allowing for a deeper understanding of the mechanisms of
adhesion formation in acute intestinal obstruction (AIO) and the justification of effective
preventive measures. A total of 300 patients with a confirmed diagnosis of AIO who underwent
surgical treatment in specialized surgical departments were included in the study. The results are
grouped according to the main research directions.
Identification of Risk Factors for Adhesion Formation.
An analysis of the medical histories
of 300 patients revealed several factors that significantly increase the risk of adhesion formation.
One of the most critical factors was the duration of surgical intervention: among patients whose
surgery lasted more than 90 minutes, the incidence of adhesions reached 65%, whereas for
shorter procedures, this rate was around 35% (p < 0.001). This result may be attributed to
increased tissue trauma and a broader inflammatory response zone during prolonged surgeries. It
was also established that a history of chronic inflammatory abdominal diseases (e.g., colitis,
Crohn’s disease, chronic appendicitis) significantly increases the risk of developing dense and
extensive adhesions (p < 0.01). These conditions are associated with persistent inflammation,
leading to elevated levels of pro-inflammatory cytokines and increased fibroblast activity.
Another significant risk factor was the use of traditional open surgical techniques: 72% of these
patients later developed pronounced adhesions. In contrast, among those operated on using
laparoscopic techniques, only 34% developed significant adhesions (p < 0.001). This finding
highlights the importance of minimizing surgical trauma and underscores the potential of
minimally invasive procedures as a key element in adhesion prevention. Additionally,
inflammatory markers in the blood, such as C-reactive protein (CRP) and interleukin-6 (IL-6),
were of particular interest. Patients with CRP levels above 10 mg/L and IL-6 levels above 15
pg/mL were more likely to develop dense adhesions, complicating the postoperative period.
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
510
Thus, heightened inflammatory activity may serve as a predictor of adverse outcomes,
emphasizing the necessity of early diagnosis and targeted anti-inflammatory therapy.
Table 1. Risk Factors for Adhesion Formation
Risk Factor
Frequency (Patients)
p-value
Surgery duration > 90
minutes
65%
< 0,001
Inflammatory
abdominal
diseases
52%
< 0,01
Open surgery
72%
< 0,001
CRP level > 10 mg/L
67%
< 0,01
IL-6 level > 15 pg/mL
70%
< 0,001
Experimental Evaluation of the Effectiveness of Preventive Measures.
Experimental studies
were conducted on laboratory animals, simulating conditions similar to surgical practice in acute
intestinal obstruction (AIO). The animals were divided into two groups: a control group (without
the use of specialized barrier materials) and a main group, where hyaluronic acid-based
membranes were applied. In the control group, the incidence of massive adhesion formation
reached 62%, which aligns with literature data indicating a high tendency for adhesion formation
following peritoneal trauma. In the experimental group, which received anti-adhesive materials,
this rate decreased to 18% (p < 0.001). Histological analysis of tissue samples showed that the
use of barrier films limited fibroblast migration and prevented excessive collagen deposition,
significantly reducing the intensity of the adhesion process. Macroscopic evaluation also
revealed a more "mild" and localized adhesion formation in animals treated with anti-adhesive
films, whereas the control group exhibited multiple dense adhesions that impaired the functional
state of intestinal loops. These findings indicate the potential of such materials in clinical
practice to reduce the risk of postoperative complications.
Table 2. Effectiveness of Anti-Adhesive Materials
Group
Massive Adhesion
Rate (%)
Inflammation
Intensity (points)
p-value
Control group (no
barrier material)
62%
7 ± 1,2
-
Hyaluronic
acid-
based membrane
18%
3 ± 0,8
< 0,001
The role of molecular markers in prognosis.
One of the key findings of the study was the
identification of the significance of molecular and genetic markers in adhesion formation.
Polymerase chain reaction (PCR) methods revealed that patients with COL1A1 and COL3A1
gene polymorphisms had a higher predisposition to excessive collagen production and,
consequently, the formation of dense adhesions. The presence of such genetic variations in
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
511
structural protein genes indicated a hyperplastic nature of regeneration, leading to persistent
tissue adhesion. Additionally, cytokine and growth factor levels were analyzed, with
transforming growth factor-beta (TGF-β) being particularly significant. A TGF-β concentration
above 50 ng/mL correlated with pronounced collagen formation (r = 0.68; p < 0.001). Thus,
genetic screening combined with biochemical marker assessment may serve as a foundation for
determining an individualized risk of adhesion formation. This approach could enable the
selection of optimal preventive measures even before surgery.
Table 3. Molecular and Genetic Markers
Marker
Mean
Level
in
Patients
with
Adhesions
Mean
Level
in
Patients
without
Adhesions
p-value
CRP (мг/л)
15,2 ± 3,1
8,5 ± 2,2
< 0,01
IL-6 (пг/мл)
18,7 ± 4,0
10,3 ± 2,5
< 0,001
TGF-β (нг/мл)
55,4 ± 6,8
35,2 ± 5,4
< 0,001
COL1A1,
COL3A1*
Polymorphisms in
28%
Polymorphisms in
11%
< 0,01
Development of a Prognostic and Preventive Algorithm.
Based on the obtained data, an
algorithm was proposed that includes several key steps: preoperative testing (measurement of
CRP, IL-6, TNF-α, TGF-β levels and analysis for the presence of COL1A1 and COL3A1
polymorphisms), optimization of surgical tactics with a priority on laparoscopy, the use of anti-
adhesive barrier materials, and an early rehabilitation program (patient activation, physiotherapy,
rational antibiotic and immune correction therapy, and nutritional support). This approach allows
for the individualization of therapeutic measures and ensures the timely identification of high-
risk patients who require more intensive prevention.
Clinical Outcomes of Implementation.
In a group of 150 patients who underwent the proposed
algorithm, a significant reduction in adhesion formation was observed: the incidence of
adhesions decreased from 48% to 22% (p < 0.001), the rate of recurrent hospitalizations due to
recurrent acute intestinal obstruction (AIO) dropped from 34% to 10% (p < 0.001), and the
average length of hospital stay was reduced from 14 ± 3 days to 9 ± 2 days (p < 0.01).
Additionally, a follow-up was conducted for 6–12 months after discharge, during which no
severe postoperative complications related to adhesion formation were recorded. According to
the SF-36 scale, patients showed faster recovery of physical activity and a reduction in pain
syndrome.
Table 4. Clinical Outcomes of Algorithm Implementation
Indicator
Before
Implementation
(n=150)
After
Implementation
(n=150)
p-value
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
512
Adhesion formation rate
(%)
48%
22%
< 0,001
Recurrent hospitalizations
(AIO recurrence) (%)
34%
10%
< 0,001
Average length of hospital
stay (days)
14 ± 3
9 ± 2
< 0,01
Severe
complications
(peritonitis, abscess) (%)
7%
3%
< 0,05
Socio-economic significance.
Reducing the number of recurrences of acute intestinal
obstruction (AIO) and shortening the duration of hospitalization have a direct impact on the
economic efficiency of medical care. According to calculations based on a comparative cost
analysis, the savings per patient amounted to approximately 25%. Overall, this leads to the
optimization of material resource allocation and more rational use of hospital beds. Moreover,
the reduction in repeat surgical interventions and the improvement of rehabilitation outcomes
positively affect the overall socio-economic situation by increasing patient productivity and
reducing the financial burden on the healthcare system.
Table 5. Costs and Economic Efficiency
Indicator
Before Algorithm
Implementation
After
Algorithm
Implementation
Savings (%)
Average treatment
cost per patient
(USD)
3000
2250
25%
Repeat surgeries (%
of total)
20%
8%
-
Total costs for a
group
of
150
patients (USD)
450 000
337 500
25%
DISCUSSION OF RESULTS
The results of the conducted study confirm the high significance of a comprehensive approach to
predicting and preventing adhesions in acute intestinal obstruction (AIO). Compared to
previously published works by foreign researchers (Ellis H., Menzies D., Kamel R.) and
domestic scientists (Saidov Z.A., Nazarov O.T., Norov B.K.), the obtained data demonstrate new
opportunities for a personalized approach to adhesion risk management. Risk Factor Analysis:
The identified key risk factors, such as the duration of surgical intervention, the presence of
inflammatory processes in the abdominal cavity, and the use of open surgical methods, are
consistent with the findings of Holmdahl E. and Wang H. [1;2]. However, our study focused on
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
513
molecular-biological markers, such as TGF-β levels and genetic predispositions (COL1A1,
COL3A1), which expand predictive capabilities and open up prospects for the implementation of
genetic screening in clinical practice. Effectiveness of Anti-Adhesion Materials Experimental
data confirm the results of studies by diZerega G.S. and Holmdahl E., which also demonstrated a
reduction in adhesion formation rates with the use of barrier materials [3;4]. However, our study
additionally revealed a correlation between the effectiveness of these materials and the levels of
inflammatory markers (CRP, IL-6), highlighting the necessity of comprehensive preoperative
preparation to optimize outcomes. The inclusion of an early rehabilitation program (fast-track
surgery) has proven effective in reducing recurrence rates and shortening hospitalization duration.
These findings align with studies conducted by Parker T. et al. However, our study additionally
confirmed the importance of integrating nutritional support and physiotherapy in the
postoperative period [5;6]. The implementation of the proposed algorithm has significant
economic importance, as evidenced by a 25% reduction in patient treatment costs. This finding
aligns with studies conducted in CIS countries (Ivanov A.I., Petrov V.S.). However, the
proposed approach incorporates additional measures, such as the use of molecular-biological
markers and treatment individualization, which enhance its effectiveness [7;8]. Comparison with
International Experience: Scientific data on the use of anti-adhesion barriers and minimally
invasive techniques are widely represented in international literature. However, in the context of
Uzbekistan, the developed algorithm has been adapted for the first time to local clinical and
socio-economic conditions. This makes our study particularly relevant for resource-limited
countries, where the rational use of new technologies is of key importance. Study Limitations:
Despite the significant results obtained, our study has certain limitations. First, a longer
observation period is required to assess long-term outcomes. Second, multicenter studies are
needed to confirm the universality of the proposed algorithm. Third, the economic evaluation of
the algorithm’s implementation requires further analysis to account for long-term effects.
CONCLUSION
The conducted study has provided important scientific and practical data on the mechanisms of
adhesion formation in acute intestinal obstruction (AIO) and has led to the development of
effective approaches for their prediction and prevention. It was established that the key risk
factors include surgical procedures lasting more than 90 minutes, chronic inflammatory
processes in the abdominal cavity, and the use of traditional open surgical methods. Patients with
elevated levels of C-reactive protein (CRP > 10 mg/L) and interleukin-6 (IL-6 > 15 pg/mL) were
found to have a significantly higher risk of developing extensive adhesions. Experimental studies
confirmed the high efficacy of anti-adhesion barrier materials. The use of hyaluronic acid and
carboxymethylcellulose-based membranes reduced the incidence of extensive adhesions from
62% to 18%. These materials limit fibroblast migration, reduce inflammation intensity, and
prevent excessive collagen deposition, demonstrating their strong preventive value. The analysis
of molecular and genetic markers such as COL1A1, COL3A1, and TGF-β highlighted their
significance in predicting adhesion risk. Genetic screening, combined with inflammatory marker
assessment, allows for the identification of high-risk groups and the development of
individualized prevention strategies. Based on the obtained data, a comprehensive prevention
algorithm was developed and implemented. This algorithm includes preoperative testing,
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
514
minimizing surgical trauma with a preference for minimally invasive methods, the use of anti-
adhesion materials, and an early rehabilitation program. Its implementation reduced adhesion
rates from 48% to 22% and hospital readmissions due to recurrent AIO from 34% to 10%. The
average length of hospitalization decreased from 14 ± 3 days to 9 ± 2 days, indicating improved
treatment and rehabilitation outcomes. The study results also demonstrate the significant socio-
economic impact of the proposed approaches. A reduction in recurrence rates and shorter
hospital stays led to a 25% decrease in treatment costs per patient, proving the economic
feasibility of these measures. The integration of the developed algorithm not only improves
patients' quality of life but also optimizes healthcare resource utilization. Thus, the study
confirms the high effectiveness of a comprehensive approach to adhesion prediction and
prevention in AIO. The application of modern anti-adhesion materials, molecular-biological
markers, personalized strategies, and optimized rehabilitation programs significantly improves
clinical outcomes, reduces the burden on the healthcare system, and enhances patients' quality of
life. Further multicenter studies are recommended to confirm the long-term efficacy of these
methods and adapt them for broader clinical application.
REFERENCES
1.
Ellis H., Moran B.J., Thompson J.N., et al. Adhesion-related hospital readmissions after
abdominal and pelvic surgery: a retrospective cohort study.
Lancet.
1999; 353(9163):1476-1480.
https://doi.org/10.1016/S0140-6736(98)09220-4
2.
Menzies D., Ellis H. Intestinal obstruction from adhesions—how big is the problem?
Annals of the Royal College of Surgeons of England.
1990; 72(1):60-63.
3.
Holmdahl E., Eriksson E., Al-Jabreen M., Risberg B. Fibrinolysis in human peritoneum
during operation.
Surgery.
1996; 119(6):701-705. https://doi.org/10.1016/S0039-6060(96)80114-
5
4.
Parker M.C., Wilson M.S., Menzies D., et al. The SCAR-3 study: 5-year adhesion-related
readmission risk following lower abdominal surgical procedures.
Colorectal Disease.
2005;
7(6):551-558. https://doi.org/10.1111/j.1463-1318.2005.00857.x
5.
diZerega G.S. Peritoneal surgery: a brief review of peritoneal physiology and wound
healing.
Surgical Clinics of North America.
2000; 80(1):483-515. https://doi.org/10.1016/S0039-
6109(05)70339-3
6.
Wang Z., Chen J., Cao L., et al. Risk factors and prevention of postoperative intra-
abdominal adhesions: a review.
World Journal of Gastroenterology.
2019; 25(34):5783-5792.
https://doi.org/10.3748/wjg.v25.i34.5783
7.
Kamel R.M. Prevention of postoperative peritoneal adhesions.
European Journal of
Obstetrics
&
Gynecology
and
Reproductive
Biology.
2010;
150(2):111-118.
https://doi.org/10.1016/j.ejogrb.2010.01.004
8.
Ivanov A.I., Grigoriev M.P., Petrov V.S. Pathogenesis and prevention of peritoneal
adhesions: clinical and experimental approaches.
Russian Journal of Surgery.
2019; 6:12-19.
https://doi.org/10.17116/hirurgia20190612
9.
Dmytruk O.M., Maksymchuk P.A., Doroshenko N.M. Carboxytherapy in prevention of
postoperative adhesions: experimental study.
Ukrainian Journal of Surgery.
2020; 3(2):56-63.
Volume 15 Issue 03, March 2025
Impact factor: 2019: 4.679 2020: 5.015 2021: 5.436, 2022: 5.242, 2023:
6.995, 2024 7.75
http://www.internationaljournal.co.in/index.php/jasass
515
https://doi.org/10.17309/urs2020.2.7
10.
Saidov Z.A., Nazarov O.T., Norov B.K. Efficiency of hyaluronic acid-based anti-
adhesion barriers in preventing postoperative adhesions.
Journal of Uzbek Surgery.
2023; 4:25-
32.
11.
Rahmonov A.U., Karimov S.H., Tashkentov A.N. Genetic and molecular aspects of
adhesion formation in abdominal surgery.
Uzbekistan Medical Journal.
2023; 8(3):15-21.
12.
American Society of Peritoneal Surgery (ASPS). Clinical guidelines for adhesion
prevention in abdominal surgery.
ASPS Guidelines.
2021.
13.
World Health Organization (WHO). Global burden of adhesion-related complications in
abdominal surgery.
WHO Report.
2022.
14.
Gynaecology Group. Comparative effectiveness of laparoscopy vs open surgery in
adhesion prevention.
International Journal of Obstetrics and Gynecology.
2020; 145(5):365-370.
https://doi.org/10.1002/ijog2020.145
15.
European Association for Endoscopic Surgery (EAES). Minimally invasive approaches
to reducing adhesion risk: consensus guidelines.
EAES Publication.
2021; 2:34-40.
