Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.