After a mean follow-up of 41.4 months, there have been 2 cases of ASBO recurrence in the icodextrin group and 10 cases in the control group (p < 0.05). Only one patient in the first group was submitted to surgery showing an Adhesion Severity Score = 2,

whereas three patients in the latter Ferrostatin-1 group were operated, and the ASS was respectively 3,2 and 3. In accordance with this data, the use of icodextrin 4% solution seems to be safe and effective to prevent intra-abdominal adhesion formation and the risk of re-obstruction [100]. Intergel solution (Lifecore Biomedical, Inc, Chaska, MN), which contains .5% ferric hyaluronate, is another product used for adhesion prevention. In preliminary studies it has been shown to reduce the number, severity, and extent of adhesions

in peritoneal surgery [101]. However, the use of Intergel in abdominal surgery in which the Blasticidin S in vivo gastrointestinal tract was opened still led to an unacceptably high rate of postoperative complications [102]. An interesting experimental finding is the reduction of both number and type of adhesions after postoperative stimulation of gastrointestinal motility by a prokinetic agent [103]. Finally merits mention that peritoneal infusion Aurora Kinase inhibitor with cold saline has shown to decrease the degree of postoperative intra-abdominal adhesion formation in an animal model [104]. Adhesions quantification Among the different adhesions scoring

systems which have been proposed mainly by gynecologists, the more complete and easy to use one is the PAI score proposed by Coccolini et al. [105]. In fact, specific attention should be paid to uniformity of measurement. We therefore triclocarban suggest a regimented classification system for adhesions in an effort to standardize their definition and subsequent analysis. In this way, different surgeons in different treatment centers can more effectively evaluate patients and compare their conditions to past evaluations using a universal classification system (Figure 3). This classification is based on the macroscopic appearance of adhesions and their extent to the different regions of the abdomen. Using specific scoring criteria, clinicians can assign a peritoneal adhesion index (PAI) ranging from 0 to 30, thereby giving a precise description of the intra-abdominal condition [105]. Figure 3 Peritoneal adhesion index: by ascribing to each abdomen area an adhesion related score as indicated, the sum of the scores will result in the PAI. Conclusions ASBO is a common disease. Non operative management should be attempted in absence of signs of peritonitis or strangulation.