Prevention of pelvic peritoneal adhesions

What recent developments are there in minimizing peritoneal adhesions after pelvic operations? The use of adjuncts, to be successful, must extend beyond the point, 3 days after operation, at which adhesion formation competes with mesothelial healing in shaping the serosal outcome. Most perioperative adjuncts, systemic or intraperitoneal, are of little practical value for this reason; systemic pentoxyfylline and intraperitoneal thrombokinase, extended for several days after operation, are currently attracting research in animals. The evidence that has apparently favored the use of intraperitoneal dextrans needs reexamining. Early laparoscopy 8 to 10 days after operation--the time of completion of mesothelial repair--has been efficacious in limiting adhesion formation in two large studies. Therapeutic second-look laparoscopy is also playing an increasing role in evaluating the use of old and new adjuncts in preventing adhesions. New adjuncts include two promising surgical barriers, one absorbable (oxygenated regenerated cellulose, or Intercede) and one nonabsorbable (polytetrafluoroethylene, or Gore-Tex).