title: Adhesion prevention after cesarean delivery: evidence, and lack of it.
abstract: In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Asnat
authors.initials: A
authors.lastname: Walfisch
authors.affiliation: Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Beloosesky
authors.affiliation: Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Shrim
authors.affiliation: Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Hallak
mesh_terms: D058107:Abdominal Wound Closure Techniques; D002585:Cesarean Section / Q000379:methods*; D017604:Cesarean Section, Repeat / Q000379:methods; D005260:Female; D006801:Humans; D010532:Peritoneal Diseases / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery*; D011247:Pregnancy; D000267:Tissue Adhesions / Q000517:prevention & control; D014591:Uterine Diseases / Q000517:prevention & control*
keywords: adhesion barriers; pelvic adhesions; peritoneal closure; repeat cesarean section