Adhesion prevention in gynaecological surgery.

Area of Science:

• Gynecological Surgery
• Adhesion Formation
• Surgical Technique

Background:

• Postoperative adhesions are a common complication of gynecological surgery, leading to potential morbidity.
• Understanding the etiology and incidence of adhesions is crucial for effective prevention strategies.

Purpose of the Study:

• To review the causes, incidence, and risk factors for adhesion formation after gynecological surgery.
• To evaluate the evidence for available methods of adhesion prevention in gynecological procedures.

Main Methods:

• Comprehensive literature search of Medline, EMBASE, and Cochrane Library (1990-2009).
• Inclusion of systematic reviews, RCTs, controlled trials, cohort studies, and meta-analyses.
• Inclusion of grey literature from health technology assessment agencies and clinical trial registries.

Main Results:

• Meticulous surgical technique, including minimizing tissue trauma and ensuring hemostasis, is vital for adhesion prevention.
• Adhesion barriers like polytetrafluoroethylene (Gore-Tex) and sodium hyaluronate/carboxymethylcellulose (Seprafilm) show efficacy.
• Oxidized regenerated cellulose (Interceed) is effective if hemostasis is achieved but may increase adhesion risk otherwise.

Conclusions:

• Minimally invasive surgical approaches (e.g., laparoscopic) are preferred to reduce adhesion risk.
• Careful tissue handling and minimizing trauma during surgery are essential preventive measures.
• Adhesion barriers can be considered for high-risk patients, with specific choices dependent on surgical site conditions.