Adhesion prevention in the surgical treatment of pelvic endometriosis

Abstract

Objective To review and to discuss the current approaches which may be proposed to prevent adhesions in the surgical management of pelvic endometriosis. Methods The current literature was reviewed using a Medline search and data from the Cochrane Library. Results and conclusions Although not demonstrated in adequately designed prospective randomized trials, laparoscopy is considered to be less adhesiogenic than laparotomy. Adhesion re‐formation is still a major problem after laparoscopy. The use of barrier agents, such as Interceed, or solutions such as Intergel should be considered in patients treated for moderate or severe endometriosis. Although effective, these products are not substitutes for a good surgical technique. As the treatment of adhesions is difficult, every effort should be made to prevent adhesion formation. To prevent severe postoperative adhesion formation, the following rules are proposed. Laparotomy should be avoided whenever possible. When the surgical treatment appears too difficult, a preoperative medical treatment may be used to delay the treatment, to facilitate the procedure, and to avoid a laparotomy. Laparoscopic procedures should be performed according to the principles of microsurgery which have been demonstrated to reduce adhesion formation at laparotomy.

A modern biomaterial for adhesion prevention

“…[60][61][62][63][64][65][66] An increase in adnexal adhesion score category indicates a worse prognosis for pregnancy. Prognostic categories for minimal (score, 0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) scores are provided for each patient group (Table II). The number of individual adnexal adhesion scores (Table IIIA) that improved or stayed the same from first-to second-look laparoscopy versus those that worsened reveals a significant treatment benefit from the use of peritoneal formulation (87 vs. 32% respec-tively; p < 0.01).…”

A modern biomaterial for adhesion prevention

“…[60][61][62][63][64][65][66] An increase in adnexal adhesion score category indicates a worse prognosis for pregnancy. Prognostic categories for minimal (score, 0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) scores are provided for each patient group (Table II). The number of individual adnexal adhesion scores (Table IIIA) that improved or stayed the same from first-to second-look laparoscopy versus those that worsened reveals a significant treatment benefit from the use of peritoneal formulation (87 vs. 32% respec-tively; p < 0.01).…”

MMC controlled-release membranes attenuate epidural scar formation in rat models after laminectomy

“…Several different strategies have been extensively explored. Microsurgical technique ( 27 ), drug use ( 28 , 29 ) and low-dose radiation ( 30 – 32 ) have been demonstrated to be effective in rat and human models. At the same time, there are also studies on the biophysical barriers which could be applied to avoid the contact between the epidural scar and dura ( 33 , 34 ).…”

Post-operative abdominal adhesions—awareness of UK gynaecologists—a survey of members of the Royal College of Obstetricians and Gynaecologists

“…Considering the procedural risk of adhesions, the survey illustrated that, while gynaecological surgeons may be generally aware of adhesions and their consequences, their knowledge is not comprehensive. Most respondents recognised the adhesiogenic nature of undertaking surgery in patients with endometriosis where there is a heightened inflammatory response and angiogenesis [23]. The risk of adhesions following open myomectomy was also recognised, but 30% considered laparoscopic myomectomy was low risk.…”

A modern biomaterial for adhesion prevention

“…[60][61][62][63][64][65][66] An increase in adnexal adhesion score category indicates a worse prognosis for pregnancy. Prognostic categories for minimal (score, 0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) scores are provided for each patient group (Table II). The number of individual adnexal adhesion scores (Table IIIA) that improved or stayed the same from first-to second-look laparoscopy versus those that worsened reveals a significant treatment benefit from the use of peritoneal formulation (87 vs. 32% respec-tively; p < 0.01).…”

MMC controlled-release membranes attenuate epidural scar formation in rat models after laminectomy

“…Several different strategies have been extensively explored. Microsurgical technique ( 27 ), drug use ( 28 , 29 ) and low-dose radiation ( 30 – 32 ) have been demonstrated to be effective in rat and human models. At the same time, there are also studies on the biophysical barriers which could be applied to avoid the contact between the epidural scar and dura ( 33 , 34 ).…”

Post-operative abdominal adhesions—awareness of UK gynaecologists—a survey of members of the Royal College of Obstetricians and Gynaecologists

“…Considering the procedural risk of adhesions, the survey illustrated that, while gynaecological surgeons may be generally aware of adhesions and their consequences, their knowledge is not comprehensive. Most respondents recognised the adhesiogenic nature of undertaking surgery in patients with endometriosis where there is a heightened inflammatory response and angiogenesis [23]. The risk of adhesions following open myomectomy was also recognised, but 30% considered laparoscopic myomectomy was low risk.…”

A modern biomaterial for adhesion prevention

“…[60][61][62][63][64][65][66] An increase in adnexal adhesion score category indicates a worse prognosis for pregnancy. Prognostic categories for minimal (score, 0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) scores are provided for each patient group (Table II). The number of individual adnexal adhesion scores (Table IIIA) that improved or stayed the same from first-to second-look laparoscopy versus those that worsened reveals a significant treatment benefit from the use of peritoneal formulation (87 vs. 32% respec-tively; p < 0.01).…”

MMC controlled-release membranes attenuate epidural scar formation in rat models after laminectomy

“…Several different strategies have been extensively explored. Microsurgical technique ( 27 ), drug use ( 28 , 29 ) and low-dose radiation ( 30 – 32 ) have been demonstrated to be effective in rat and human models. At the same time, there are also studies on the biophysical barriers which could be applied to avoid the contact between the epidural scar and dura ( 33 , 34 ).…”

Post-operative abdominal adhesions—awareness of UK gynaecologists—a survey of members of the Royal College of Obstetricians and Gynaecologists

“…Considering the procedural risk of adhesions, the survey illustrated that, while gynaecological surgeons may be generally aware of adhesions and their consequences, their knowledge is not comprehensive. Most respondents recognised the adhesiogenic nature of undertaking surgery in patients with endometriosis where there is a heightened inflammatory response and angiogenesis [23]. The risk of adhesions following open myomectomy was also recognised, but 30% considered laparoscopic myomectomy was low risk.…”