A review of the problematic adhesion prophylaxis in gynaecological surgery

Abstract

BackgroundAdhesions lead to considerable patient morbidity and are a mounting burden on surgeons and the health care system alike. Although adhesion formation is the most frequent complication in abdominal and pelvic surgery, many surgeons are still not aware of the extent of the problem. To provide the best care for their patients, surgeons should consistently inform themselves of anti-adhesion strategies and include these methods in their daily routine.MethodsSearches were conducted in PubMed and The Cochrane Library to identify relevant literature.FindingsVarious complications are associated with adhesion formation, including small bowel obstruction, infertility and chronic pelvic pain. Increasingly, an understanding of adhesion formation as a complex process influenced by many different factors has led to various conceivable anti-adhesion strategies. At present, a number of different anti-adhesion agents are available. Although some agents have proved effective in reducing adhesion formation in randomised controlled trials, none of them can completely prevent adhesion formation.ConclusionTo fulfil our duty to provide best possible care for our patients, it is now time to regard adhesions as the most common complication in surgery. Further research is needed to fully understand adhesion formation and to develop new strategies for adhesion prevention. Large clinical efficacy trials of anti-adhesion agents will make it easier for surgeons to decide which agent to use in daily routine.

Combined Hemostasis and Adhesion Prevention with the Novel Agent 4DryField<sup>®</sup> PH—Initial Observations

“…In further course, adhesion formation must be regarded as the most common complication occurring after 60% -90% of procedures [5]- [7]. Adhesions are responsible for a long list of sequelae ranging from the most frequent one, i.e.…”

Safety of Laparoscopically Assisted Vaginal Hysterectomy for Women with Anterior Wall Adherence after Cesarean Section

“…More severe adhesions occur with increasing numbers of cesarean section. In such cases, additional adhesiolysis might be required during surgery and this could extend the operative time along with the increased possibility of more blood loss and prolonged hospital stay [11,12].…”

Abdominal and Pelvic Adhesions Research in Sub-Saharan Africa: Air Must Become Wind

“…16,17 Overall, 20 to 40 % of infertility cases are secondary to APA. 17,18 Studies in SSA showed that fibrosis, particularly through APA, ranked first in etiologies of secondary female infertility [19][20][21] which is the most common type in this part of the world. 19,22 Women experiencing the drama of infertility generally present with tubal factor infertility 20,21 requiring expensive therapies.…”