Adhesion prevention in gynecologic surgery.
The objectives of this study are to evaluate the magnitude of postsurgical adhesions clinically, their impact on the hospital budget, and the available adhesion-reducing substances. We conducted a review of relevant literature on intraabdominal adhesion, adhesion-reducing substances, and their related cost. The relevance of adhesions to gynecology not only relates to infertility and abdominal pain, but also to the occurrence of bowel obstruction. There have been many substances and materials used to decrease the adhesion formation. However, there is still no adhesion-reducing substance that is unequivocally effective. Its use is also costly. The most common cause of small-bowel obstruction is postsurgical adhesions. Indeed, more than one half of patients with adhesion-related small-bowel obstruction had previous gynecologic operations, and a high percentage occurs after abdominal hysterectomy. To date, there has been no study suggesting that the use of adhesion-reducing substances decreases the risk of bowel obstruction or the long-term costs to the healthcare system. The long-awaited substance or barrier that unequivocally prevents adhesion formation is yet to come.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to list the causes of small bowel obstruction, to describe the commercially available adhesion-reducing substances, and to compare the efficacy of the various adhesion-reducing substances.
Al-Jaroudi
Dania
D
McGill University, Montreal, Quebec, Canada.
Tulandi
Togas
T
D001672:Biocompatible Materials; D002483:Cellulose, Oxidized; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid; D007322:Instillation, Drug; D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000517:prevention & control*; D000267:Tissue Adhesions / Q000517:prevention & control*
D001672:Biocompatible Materials; D002483:Cellulose, Oxidized; C060002:INTERCEED; D008567:Membranes, Artificial; C118198:Seprafilm; D011138:Polytetrafluoroethylene; D006820:Hyaluronic Acid