Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies

Abstract

Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.

Adhesion barriers in cardiac surgery: A systematic review of efficacy

“…Cova CARD is a relatively new barrier that acts as a resorbable, malleable porcine collagen membrane, promoting tissue regeneration. 3,17 While data in human subjects are limited, collagen sheets have been shown to resemble native pericardial membranes at 24 weeks after operation in animal models. 3,39 The adhesion formation rate may be greater relative to PTFE; however, the improved TSS suggests that this barrier may provide easier dissection than PTFE.…”

“…3,17 While data in human subjects are limited, collagen sheets have been shown to resemble native pericardial membranes at 24 weeks after operation in animal models. 3,39 The adhesion formation rate may be greater relative to PTFE; however, the improved TSS suggests that this barrier may provide easier dissection than PTFE. Adhesion formation occurred with almost every patient when using Seprafilm (95.83% vs. control: 94.12%), COSEAL (100.00%), REPEL-CV (100.00%; control: 100.00%), Silicone Rubber (100.00%), Polyglycolic Acid Mesh (100.00% vs. control: 100.00%), and Porcine and Polyester Gelatin Sheet (100.00%).…”

“…3 Nonresorbable barriers include both prosthetic and/or xenograft materials, while bioresorbable barriers include pharmacologic agents and/or resorbable membranes. 3,4 Nonresorbable barriers create indefinite physical separation between tissue planes and preserve a readily discernable surgical space at reoperation. Nonresorbable barriers were the first type of products developed to prevent PPAs.…”

Efficacy of Cross-Linked Hyaluronic Acid Gel for the Reduction of Post-operative Obstructive Symptoms Due to Adhesions

“…However, no conclusive data has been found regarding their efficacy. Furthermore, they also have a number of drawbacks related to systemic action and other adverse effects [ 11 ]. This has thus led to an increased interest in the prevention of adhesions by the use of barriers.…”

“…Various pharmaceutical compositions of hyaluronic acid are used to prevent the formation of postsurgical scars, adhesions, and keloid formation in connection with various surgical procedures. Animal and human studies have shown that hyaluronic acid offers a reduction of postoperative adhesions [ 11 ].…”