Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Abstract

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.

Prevalence of Intrauterine Adhesions after Myomectomy: A Prospective Multicenter Observational Study

“…Intrauterine adhesions are an underestimated complication of uterine surgery, consisting of fibrous bands between the uterine wall that can completely obliterate the uterine cavity [18]. In up to 50% of cases, intrauterine adhesions are asymptomatic and often remain undiagnosed [19].…”

Adherencias abdominales postoperatorias: patogénesis y técnicas actuales de prevención

“…Los especialistas en microcirugía han aceptado que el manejo de los tejidos blandos con guantes es menos traumático que el contacto con instrumentos quirúrgicos 2 . En modelos animales se ha comprobado que el tiempo quirúrgico y el sangrado perioperatorio aumentan la incidencia de AAP al haber mayor daño tisular inducido 14 . La mayoría de los estudios coinciden en que la laparoscopia reduce de manera importante la formación de AAP en comparación con la laparotomía abierta 3,[15][16][17] .…”