Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence.
Post-operative adhesions are a significant complication of all abdominal surgical procedures. The major strategies for adhesion prevention in gynaecological surgery are focused on the optimization of surgical technique and use of anti-adhesive agents, which fall into two main categories: pharmacological agents and barriers. Surgical technique that minimizes peritoneal trauma can reduce, but cannot prevent post-operative adhesion formation. Various local and systemic drugs that can alter the local inflammatory response, inhibit the coagulation cascade and promote fibrinolysis have been evaluated. Limited data support the administration of post-operative corticosteroids in addition to systemic intra-operative corticosteroids for the prevention of adhesions after gynaecological surgery. None of the remaining pharmacological agents have been found effective for the reduction of post-operative adhesions. Barriers are currently considered the most useful adjuncts, which may reduce adhesion formation. They act by separating the traumatized peritoneal surfaces during the healing period. The separation can be achieved by solid barriers or fluids. There is limited evidence from randomized clinical trials that support the beneficial effect of most of these barrier agents in the prevention of intra-peritoneal adhesions after gynaecological surgery. However, the evidence is not adequate for definite conclusions to be drawn and further research in this field is warranted.
Pados
G
G
1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Peripheral Road, Nea Efkarpia 546 03, Thessaloniki, Greece. padosgyn@hol.gr
Venetis
C A
CA
Almaloglou
K
K
Tarlatzis
B C
BC
D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology; D000925:Anticoagulants / Q000494:pharmacology; D001672:Biocompatible Materials; D004967:Estrogens / Q000494:pharmacology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006633:Histamine Antagonists / Q000494:pharmacology; D006801:Humans; D008954:Models, Biological; D010532:Peritoneal Diseases / Q000209:etiology / Q000517:prevention & control*; D011108:Polymers; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011374:Progesterone / Q000494:pharmacology; D012996:Solutions; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D001672:Biocompatible Materials; D004967:Estrogens; D006633:Histamine Antagonists; D011108:Polymers; D012996:Solutions; D011374:Progesterone