A comprehensive approach to the diagnosis, treatment and prevention of peritoneal adhesive disease taking into account genetic and biochemical disorders

Abstract

Etiological factors of adhesion formation are diverse. These include mechanical damage to the peritoneum, foreign material entering the abdominal cavity and infectious inflammation of the peritoneum. Operations are and remain the main cause of adhesive disease of the peritoneum. Adhesive disease of the peritoneum causes acute intestinal obstruction in 32% of cases. Prediction and prevention of adhesive disease are extremely important. In the pathogenesis of adhesions, the main role belongs to hereditary predisposition. The FN1 gene takes an active part in the formation of fibronectin (plasma and cellular). Fibronectin plays a major role in the acute phase of inflammation, in the processes of cell adhesion, angiogenesis, and has a collagen binding domain. The VWF gene has domains responsible for the synthesis of a multimeric glycoprotein, which is involved in platelet adhesion during acute inflammation and vascular wall damage, collagen binding, and acts as a cofactor for factor VIII. Collagen binding domain The VWF gene of the VWF gene has been practically unstudied. These genes affect the processes of adhesion formation in the abdominal cavity during peritoneal damage. Purpose: to study and compare the results of diagnostics, treatment, and prevention of peritoneal adhesive disease. Materials and methods. During the period from 2013 to 2025, 125 patients with adhesive disease were examined and treated. Using the differential chromosome staining method, the frequency of possible mutations of the FN1 genes (located on the short arm of chromosome II) and VWF (located on the short arm of chromosome XII) was studied in 45 patients. Using immunoenzymatic methods, quantitative indicators of fibronectin and collagen binding activity of von Willebrand factor were determined in the blood. In order to determine the effect of the hyaluronic acid preparation, the treatment of 80 patients was analyzed. Research results. Analysis of the results of the examination of genetic factors in patients with acute adhesive intestinal obstruction indicates the presence of a relationship between the pronounced polymorphism of the FN1 and VWF genes and the severity of the manifestation of the syndrome complex of adhesive disease. Thus, in the presence of 2 mutant genes of FN1 and VWF in patients, the number of symptoms characterizing the severe course of adhesive disease of the peritoneum was maximum. In the group of incisional ventral hernias, the presence of aberrations of other genomes, including ITGA 2, indicates a violation of the quality of collagen protein synthesis, especially type V. Analysis of the results of the examination of genetic factors and immunoenzymatic indicators clearly showed their relationship. In the presence of chromosomal aberrations, corresponding biochemical disorders are observed. The effectiveness of the use of the hyaluronic acid preparation in patients after planned surgical interventions has been proven. However, after urgent enterolysis and the use of the preparation, an improvement in immediate results is visible, but the long-term results are practically the same. Conclusions. 1. The presence of polymorphism of the FN1 and VWF genes in patients with acute adhesive intestinal obstruction has been studied. 2. In the presence of chromosomal aberrations, corresponding biochemical disorders are observed. 3. The hyaluronic acid preparation is effective in planned surgical interventions, but ineffective in urgent operations for acute adhesive intestinal obstruction. 4. It is necessary to differentiate adhesive peritoneal disease in patients with manifest acute adhesive intestinal obstruction and patients with incisional ventral hernias. 5. It is necessary to search for and introduce new anti-adhesive drugs