Management and prevention of pelvic adhesions

Postsurgical adhesion formation is an important clinical problem within all surgical specialties. In gynecology, adhesions resulting from gynecologic procedures are a major clinical, social, and economic concern because they may result in pelvic pain, infertility, or bowel obstruction. In addition, it may lead to additional surgery to resolve the adhesion-related complications. This review evaluates the available evidence regarding the effectiveness of various strategies for reducing postsurgical adhesions. Those strategies include surgical techniques and adhesion-reducing substances. Postsurgical adhesions are natural consequences of tissue trauma and healing. Our review indicates that most of the effective adhesion-reducing substances decrease adhesion formation and reformation, but they do not prevent its occurrence. In fact, there is no single modality proven to be unequivocally effective in preventing adhesion formation. Current evidence suggests that the use of ORC (Interceed; Gynecare, Somerville, NJ), e-PTFE (Gore-Tex Surgical Membrane, Preclude; WL Gore, Flagstaff, AZ), HA-CMC (Seprafilm; Genzyme, Cambridge, MA), or 4% icodextrin (Adept; Baxter BioSurgery, Deerfield, IL) is justified. Their use, however, should not replace good surgical techniques. We recommend the use of microsurgical principles, minimally invasive surgery, and the use of adhesion-reducing agents.