Prevention of adhesions in gynaecological endoscopy

Abstract

Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.

Laparoscopic Strassman’s metroplasty for bicornuate uterus

“…Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem [11]. Minimal adhesion formation after laparoscopic metroplasty for bicornuate and didelphic uteri has been reported in previous studies [5,7].…”

Pathogenetic mechanisms of posttraumatic fibrosis of the uterus of white rats

“…Considering our data, it is appropriate to emphasize that a significant proportion of publications devoted to the problem of preventing and treating post-surgical adhesions in women, includes information on the use of various pharmacological drugs used to suppress inflammatory responses [13], maintaining the effectiveness of antioxidant protection [14], humoral regulation of metabolism of collagen [15] and neoangiogenesis [16,17], as well as an analysis of the features of the technology gynecological operations [18]. However, most authors emphasize the special role of the cytokine family of TGF-beta in the mechanisms of wound healing in gynecological operations and their involvement in pathological changes in repair processes, leading to the formation of adhesions [2,3].…”

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

“…Any trauma to the basal layer of the endometrium may lead to the formation of de novo IUAs; nearly 90 % of all cases of IUAs are associated with postpartum or postabortion dilatation and curettage [18]. The etiological role of infection in the formation of IUAs is, with the exception of genital tuberculosis, controversial [8].…”