Barrier agents for preventing adhesions after surgery for subfertility

Area of Science:

• Gynecology
• Surgical Innovation
• Reproductive Medicine

Background:

• Pelvic adhesions, resulting from inflammation, endometriosis, or surgical trauma, can cause complications.
• Mechanical barriers are used during pelvic surgery to prevent tissue surfaces from adhering.
• Commercially available barriers include oxidised regenerated cellulose (Interceed) and polytetrafluoroethylene (Gore-Tex).

Purpose of the Study:

• To evaluate the effectiveness of mechanical barriers in preventing postoperative pelvic adhesion reformation.
• To assess the impact of these barriers on pregnancy rates and pelvic pain in women of reproductive age.

Main Methods:

• A systematic review of randomized controlled trials and controlled clinical trials was conducted.
• Trials compared different barriers, no treatment, or other barriers in women undergoing fertility-preserving pelvic surgery.
• Eligibility and quality of trials were assessed by reviewers.

Main Results:

• Fifteen trials were included, utilizing laparoscopy or laparotomy.
• Interceed reduced pelvic adhesion formation in both new and re-formed adhesions.
• Gore-Tex demonstrated greater effectiveness in preventing adhesions compared to Interceed or no barrier.
• Seprafilm showed limited effectiveness in preventing adhesions after myomectomy.

Conclusions:

• Interceed effectively reduces pelvic adhesion formation but lacks sufficient data to support improved pregnancy rates.
• Gore-Tex may be superior to Interceed for adhesion prevention, though its application requires suturing and removal.
• Seprafilm did not demonstrate effectiveness in preventing adhesion formation.