Adhesion prevention in gynecologic surgery.
OBJECTIVE
The purpose of this review is to discuss new substances and techniques to prevent post-surgical adhesion formation.


RESULTS
Intraperitoneal administration of sprayable hydrogel and hyaluronic acid appears to decrease postmyomectomy adhesions. Intrauterine instillation of auto-crosslinked hyaluronic acid is associated with fewer intrauterine adhesions. Temporary abdominal oophoropexy after surgery of stage III and IV endometriosis might be beneficial in reducing ovarian adhesion.


CONCLUSIONS
There has been a wide range of adhesion-reducing substances evaluated in animal models. However, in clinical situations, no adhesion-preventing substance, material, or barrier is unequivocally effective. In view of surgical technique, compared to laparotomy, the laparoscopic approach is associated with less adhesion formation. Temporary abdominal oophoropexy may provide a promising technique to prevent ovarian adhesions. Future research should also be directed toward preventing intrauterine adhesions.
Department of Obstetrics and Gynecology, McGill University, Canada. togas.tulandi@mcgill.ca
Togas
T
Tulandi
Abdulaziz
A
Al-Shahrani
D000818:Animals; D005260:Female; D005831:Genital Diseases, Female / Q000517:prevention & control*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D006820:Hyaluronic Acid; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D011183:Postoperative Complications / Q000517:prevention & control*; D000267:Tissue Adhesions / Q000517:prevention & control; D014810:Vitamin E
D014810:Vitamin E; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D006820:Hyaluronic Acid