World Journal of Laparoscopic Surgery

Register      Login

VOLUME 7 , ISSUE 2 ( May-August, 2014 ) > List of Articles

REVIEW ARTICLE

Adhesion Prevention in Operative Gynecology: How Realistic are our Expectations?

Shyjus Puliyathinkal, KP Abdul Vahab, N Umadevi, KC Geetha, P Mumtaz, Aswathy Govind, Pavithra Mahesh, Ayisha Hashim

Citation Information : Puliyathinkal S, Vahab KA, Umadevi N, Geetha K, Mumtaz P, Govind A, Mahesh P, Hashim A. Adhesion Prevention in Operative Gynecology: How Realistic are our Expectations?. World J Lap Surg 2014; 7 (2):88-91.

DOI: 10.5005/jp-journals-10033-1222

Published Online: 01-08-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Materials and methods

We analyzed 18 published articles to critically look at the effectiveness of adhesive barriers in operative gynecology. A literature research was performed using internet.

Discussion

Oxidized regenerated cellulose (Interceed) was found to be an effective adhesion barrier with treated sidewalls showing significantly less area involved with adhesions (p < 0.05). With 4% icodextrin solution (Adept), no significant reduction of de novo adhesions was found in patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts (p = 0.909). With use of hyaluronic acid (Intergel), a significant difference was found in the mean adhesion severity scores (p < 0.05). The Sepracoat group had a significantly lower incidence of de novo adhesions in terms of proportion of sites involved, percentage of adhesion free patients as well as adhesion extent and severity. Oxiplex was found to prevent an increase in adhesion score when compared to placebo.

Conclusion

The decision whether to use an adhesion barrier or not, need to be a well thought out one after weighing the balance between the efficacy of the material against the cost implications involved. The quest for the best of the adhesive barriers still continues.

How to cite this article

Puliyathinkal S, Vahab KPA, Umadevi N, Geetha KC, Mumtaz P, Govind A, Mahesh P, Hashim A. Adhesion Prevention in Operative Gynecology: How Realistic are our Expectations? World J Lap Surg 2014;7(2):88-91.


PDF Share
  1. Adhesion in gynecology. Complication, cost and prevention: a review. Surg Technol Int 2005;14(1):185-190.
  2. Clinical implications of postsurgical adhesions. Hum Reprod Update 2001;7(6):567-576.
  3. Use of fibrinolytic agents in the prevention of postoperative adhesion formation. Fertil Steril 2000;74(2):203-212.
  4. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. The Cochrane Database of Systematic Reviews. Issue 2. Art No.: CD001298.pub3.
  5. Peritoneal adhesions: etiology, pathophysiology and clinical significance. Dig Surg 2001;18(1):260-273.
  6. The impact of adhesions on hospital readmissions over 10 years after 8849 open gynaecological operations: an assessment from the surgical and clinical adhesions research study. BJOG 2000;107(1):855-862.
  7. Adhesions: laparoscopic surgery versus laparotomy. Ann NY Acad Sci 2000;900(2):272-285.
  8. Adhesions in patients with chronic pelvic pain: a role for adhesiolysis? Fertil Steril 2004;82(1):1483-1491.
  9. Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL registry. Ann Roy Coll Surg Engl 2006;88(3):375-382.
  10. Cost of bowel obstruction resulting from adhesions. Eur J Surg 1997;163(9):679-684.
  11. Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am 1997;77(1):671-688.
  12. Adhesions and adhesiolysis: the role of laparoscopy. JSLS 2002;6(2):99-109.
  13. Surgical and clinical research (SCAR) group. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24,046 patients. Hum Reprod 2004;19(1):1877-1885.
  14. Use of Interceed (TC7) absorbable adhesion barrier to reduce postoperative adhesion reformation in infertility and endometriosis surgery. The Obstetrics and Gynecology Adhesion Prevention Committee. Obstet Gynecol 1992;79(1):518-522.
  15. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011;26(8):2015-2027.
  16. Reduction of postoperative adhesions with an auto-crosslinked hyaluronan gel in gynaecological laparoscopic surgery: a blinded, controlled, randomized, multicentre study. Hum Reprod 2006;21(1):1248-1254.
  17. Reduction of de novo postsurgical adhesions by intraoperative precoating with Sepracoat (HAL-C) solution: a prospective, randomized, blinded, placebo-controlled multicenter study. The Sepracoat Adhesion Study Group. Fertil Steril 1998;69(2):1067-1074.
  18. Reduction of post-operative adhesions after laparoscopic gynaecological surgery wuth Oxiplex/ AP gel: a pilot study. Fertil Steril 2005;84(1):1450-1456.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.