Postsurgical adhesion formation is a significant clinical problem within every surgical specialism. Due to the problems that adhesions cause, a wide variety of adjunctive treatments to prevent the formation and reformation of adhesions have been proposed. One of the modalities that has been studied extensively and that has been showing the most promising results is the so-called barrier method. The purpose of the present study was to compare the efficacy of five of these barrier materials in the prevention of postsurgical adhesion formation in a standardized rat adhesion model. It was concluded that no beneficial effect of Ringer's lactate on adhesion formation was seen. Significant reductions (P < 0.0001) in adhesion percentages compared to control animals were seen with Polyactive((TM)), PRECLUDE Peritoneal Membrane((TM)), Seprafilm((TM)) and Tissucol((TM)), but only PRECLUDE Peritoneal Membrane and Seprafilm significantly reduced adhesions (P < 0.01) when the barrier-treated peritoneal defects were compared with contralateral control-side peritoneal defects. The results of our study suggest that Seprafilm and PRECLUDE Peritoneal Membrane are superior to Tissucol and Polyactive in preventing adhesion formation. When Polyactive was still attached to the site of application during the second laparotomy, similar results to Seprafilm and PRECLUDE Peritoneal Membrane were seen. Future studies on the efficacy of a material to decrease adhesion formation should always include a comparison of several control materials in the same model. Our study indicates that Seprafilm or PRECLUDE Peritoneal Membrane might be used as standards of control.

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Objective The purpose of this study was to compare patient discomfort during saline infusion sonography (SIS) and office hysteroscopy performed according to a vaginoscopic approach.Design Randomised controlled trial.Setting University hospital.Population Women with an indication for further investigation of the uterine cavity.Methods A total of 100 women randomly allocated to either SIS or vaginoscopic office hysteroscopy in an outpatient clinic.Main outcome measures Scores on a visual analogue scale (VAS) for pain and a present pain intensity (PPI) scale, conclusiveness and success rate.Results The patients' pain scores on both the VAS and the PPI were lower for SIS when compared with office hysteroscopy (P < 0.05). However, in cases of severe pain (VAS > 7 or PPI > 2), there was no statistically significant difference between both groups. The success rate, defined as adequate inspection of the cervical canal and uterine cavity, was 94% for SIS compared with 92% for office hysteroscopy (P = 0.633). SIS, multiparity, shorter procedure time and position of the uterus in anteversion decreased pain scores among women studied.Conclusions Both SIS and office hysteroscopy are successful procedures and well tolerated by women. SIS induces significantly less discomfort than office hysteroscopy and should therefore be considered the method of choice.

Laparoscopic findings in 200 asymptomatic, healthy women having a sterilization were recorded; 148 patients (74%) had no abnormality and 52 patients had abnormalities comprising pelvic adhesions (14%), uterine fibromyomas (5%), endometriosis (3%) and ovarian or parovarian cysts (2%).

Objective To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions. Design Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9–12 months. Setting Department of Gynecology, Leiden University Medical Center, the Netherlands. Subjects 48 women known by laparoscopy to have stage II‐IV pelvic adhesions. Interventions Midline laparotomy and surgical adhesiolysis. Main outcome results Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities. Results 24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9–12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment. Conclusions Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.

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