Laparoscopy in gynecologic surgery: adhesion development, prevention, and use of adjunctive therapies

Laparoscopic surgery has several proven advantages over open surgery. However, the role of laparoscopy in adhesion development and applicability of adhesion barrier is unclear. Adhesions occur in majority of women undergoing major laparoscopic gynecologic surgery and its sequel, are associated with significant morbidity, economic, and medico-legal consequences. Microsurgical principles and technique alone are insufficient to prevent adhesion formation. However, several biases limit the ability to compare different types of adhesion prevention products for efficacy. It is hoped that better understanding of pathways and demonstration of the mechanisms involved in adhesions formation may help in future research into this field.