Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review

Abstract

Surgical adhesions can lead to significant consequences including abdominopelvic pain, bowel obstruction, subfertility, and subsequent surgery. Although laparoscopic surgery is associated with a decreased risk of adhesion formation, methods to further decrease adhesions are warranted. We systematically reviewed literature addressing the management, prevention, and sequelae of adhesions in women undergoing laparoscopic gynecologic surgery. We searched PubMed, EMBASE, EBSCOhost, and Cochrane Central Register of Controlled Trials and found 6566 records. The primary outcome was adhesion formation. The secondary outcomes were abdominopelvic pain, quality of life, subfertility, pregnancy, bowel obstruction, urinary symptoms, and subsequent surgery. After applying inclusion and exclusion criteria, 52 studies remained for qualitative synthesis. Risk of bias assessments were applied independently by 2 authors. There was evidence that Hyalobarrier Gel (Anika Therapeutics, Bedford, MA), HyaRegen NCH Gel (Bilar Medikal, Istanbul, Turkey), Oxiplex/AP Gel (Fziomed, Inc., San Luis Obispo, CA), SprayGel (Confluent Surgical Inc., Waltham, MA), and Beriplast (CSL Behring, LLCm King of Prussia, PA) all decrease the incidence of adhesions. Adept (Baxter, Deerfield, IL) significantly decreased de novo adhesion scores of the posterior uterus. Using an integrated treatment approach to pelvic pain significantly improved pain and quality of life compared with standard laparoscopic treatment. Lastly, Hyalobarrier Gel Endo (Anika Therapeutics, Bedford, MA) placement led to a higher pregnancy rate than no barrier usage. Our findings underscore the need for high-quality trials to evaluate the efficacy of surgical techniques, adhesion barriers, and other treatment modalities on the management and prevention of adhesions and their clinical sequelae. This review was registered on PROSPERO (ID = CRD42017068053).

A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model

“…The gel barriers probably don’t remain on the injuries surfaces and could fail to keep separate these surfaces. Moreover most of gel adhesion barriers are not approved for use in United States [ 17 ]. There is a lack of an adhesion barrier easy to use that could be use both in open surgery, laparoscopy and hysteroscopy.…”

The prevention of postoperative port-site adhesion following single-port access (SPA) laparoscopic surgeries

“…Hyaluronate/carboxy cellulose membrane (Seprafilm TM ) is one of the most extensively studied anti-adhesive agents in gynecologic surgery. [ 22 ] Several studies have reported that it effectively decreases the formation of postoperative surgical adhesion. [ 23 , 24 ] However, an important drawback of the available membranous adhesion barriers, such as Seprafilm TM , is the difficulty of handling them during laparoscopic procedures.…”

Surgical adhesions among women undergoing laparoscopic gynecological surgery with or without adhesiolysis – prevalence, severity, and implications: retrospective cohort study at a University Hospital

“…An overview of Cochrane reviews by Hindocha and colleagues 24 found insufficient evidence to withdraw any conclusions about the effectiveness and safety of anti-adhesion agents in gynecological surgery. Furthermore, Farag and colleagues 25 in a systematic review of management, prevention, and sequelae of adhesions concluded that there was a need for high-quality trials to evaluate the efficacy of surgical techniques, adhesion barriers, and other treatment modalities.…”