Adjuvant therapy for the reduction of postoperative intra-abdominal adhesion formation.
BACKGROUND
To review currently available evidence on the use of adjuvant therapy to reduce the formation of postoperative intra-abdominal adhesions.


METHODS
A search on Pubmed and the Cochrane library was undertaken using the keywords "abdominal", "adhesion", "postoperative", "prevention" and "reduction". Only randomised controlled trials, prospective non-randomised controlled studies and review articles published in the English language between 1990 and 2006 were included.


RESULTS
Two prospective non-randomised controlled studies and 18 randomised controlled trials were included in this review. Adjuvant therapies reviewed included pharmacological agents (streptokinase, recombinant tissue plasminogen activator, vitamin E antioxidant molecules), and mechanical barriers (hyaluronic acid barriers, oxidised regenerated cellulose barriers, nanofibrous barriers and collagen foils). Hyaluronate/carboxymethylcellulose-based bioresorbable membrane (Seprafilm) appeared to be the most efficacious in reducing adhesion formation as well as decreasing the incidence of adhesion obstruction requiring reoperation in clinical studies. Drawbacks to the use of Seprafilm include high cost and complications such as haemorrhage and poor wound healing.


CONCLUSIONS
Only a limited number of adjuvant treatment methods are currently available for the reduction of postoperative adhesions. Seprafilm has been proven to be the efficacious method to reduce adhesions. Investigations into the novel therapies are showing promising results in experimental studies and clinical studies before their wider application.
Cheung
Jason P Y
JP
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Tsang
Helen H L
HH
Cheung
Janice J C
JJ
Yu
Harry H Y
HH
Leung
Gilberto K K
GK
Law
Wai Lun
WL
D000818:Animals; D000975:Antioxidants / Q000008:administration & dosage*; D002483:Cellulose, Oxidized; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid; D008567:Membranes, Artificial; D011183:Postoperative Complications; D013300:Streptokinase / Q000627:therapeutic use; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014810:Vitamin E / Q000008:administration & dosage
D000975:Antioxidants; D002483:Cellulose, Oxidized; D005343:Fibrinolytic Agents; C060002:INTERCEED; D008567:Membranes, Artificial; C118198:Seprafilm; D014810:Vitamin E; D006820:Hyaluronic Acid; D013300:Streptokinase; D010959:Tissue Plasminogen Activator