Non-barrier agents for postoperative adhesion prevention: clinical and preclinical aspects

The purpose of this document is to review the non-barrier methods to prevent postoperative adhesion formation in humans.

A MEDLINE computer search was performed to identify relevant articles using the keywords "postoperative adhesion prevention" "abdominal" and "humans". Subsequent searches were performed using the keyword "non-barrier" to further supplement the information obtained. After careful review of the abstracts, 15 articles were selected for inclusion in the manuscript.

Many methods, drugs and materials have been demonstrated effective for reducing postoperative adhesion in animal models. Among them, four types of drugs have been clinically used in attempts to reduce postoperative adhesions: gonadotropin-releasing hormone agonists, anti-inflammatory drugs, humidified CO(2) and hydroflotation. Many clinical and meta-analyses revealed that hydroflotation materials do not increase adhesion-free outcome. GnRHa pretreatment using a standard clinical dose (3.75 mg monthly) before myomectomy do not decrease adhesion formation. The role of CO(2) on the reduction and/or prevention of postoperative adhesions have been reported only in cardiac surgery. None of them have been adopted for clinical standard therapy, despite positive reports in animals or preclinical applications.

In contrast to the results from animal studies, there is no substantial evidence that the use of non-barrier materials reduces postoperative abdominal adhesions in humans.