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Shyjus Puliyathinkal et al 10.5005/jp-journals-10033-1222
RevieW aRticLe

Adhesion Prevention in Operative Gynecology:

How Realistic are Our Expectations?

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1 Shyjus Puliyathinkal, KP Abdul Vahab, N Umadevi, KC Geetha, P Mumtaz, Aswathy Govind
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7 Pavithra Mahesh, Ayisha Hashim
ABSTRACT trauma is the primary contributing factor. Infection, ischemic
The purpose of this review is to critically analyze the effective- damage and exposure to foreign materials can significantly
ness of adhesive barriers in adhesion prevention in terms of contribute to this. 2
incidence and extent of postoperative adhesions and to help Adhesions can be primary or de novo adhesions vs secon­
one choose the best and the most cost-effective, among those
available in market today. dary or reformed adhesions. The former are freshly formed
Materials and methods: We analyzed 18 published articles to ones, on locations devoid of adhesions before and the latter
critically look at the effectiveness of adhesive barriers in operative are those adhesions that undergo adhesiolysis and recur at
gynecology. A literature research was performed using internet. the same location. Adhesions may also be classified based
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Discussion: Oxidized regenerated cellulose (Interceed) was
found to be an effective adhesion barrier with treated side- on the location, as intra­abdominal or intrauterine. Virtually,
walls showing significantly less area involved with adhesions any surgical procedure performed transperitoneally can
(p < 0.05). With 4% icodextrin solution (AdepT), no significant lead to adhesions ranging from minimal scarring of serosal
reduction of de novo adhesions was found in patients under-
going laparoscopic surgery for removal of myomas or endome- surface to firm agglutination of structures.
triotic cysts (p = 0.909). With use of hyaluronic acid (Intergel), a The formation of adhesions following an open approach
significant difference was found in the mean adhesion severity in gynecology is more than a common entity. It has been
scores (p < 0.05). The Sepracoat group had a significantly
lower incidence of de novo adhesions in terms of proportion of reported that intra­abdominal adhesions occur in 60 to 90%
sites involved, percentage of adhesion free patients as well as of women who have undergone major gynecological proce­
adhesion extent and severity. Oxiplex was found to prevent an dures. Further, a recent study by conducted in Scotland
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increase in adhesion score when compared to placebo.
Conclusion: The decision whether to use an adhesion barrier reported that women undergoing an initial open surgery
or not, need to be a well thought out one after weighing the for gynecological conditions had a 5% likelihood of being
balance between the efficacy of the material against the cost rehospitalized because of adhesions over the next 10 years.
implications involved. The quest for the best of the adhesive
barriers still continues. Though many adhesions resulting from gynecological
Keywords: Adhesion barriers, Oxidized regenerated cellulose, surgery have little or no detrimental effect on patients, a consi­
Interceed, Icodextrin, AdepT, Hyaluronic acid, Intergel/Hyalo- derable proportion of them can result in serious short and
barrier, Sepracoat, Viscoelastic gel, Oxiplex. long­term complications, including infertility, pelvic pain
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How to cite this article: puliyathinkal S, Vahab KpA, Umadevi N, and intestinal obstruction, resulting in a reduced quality of
Geetha KC, Mumtaz p, Govind A, Mahesh p, Hashim A. 9
Adhesion prevention in Operative Gynecology: How Realistic life often requiring readmission to hospital and additional
are Our expectations? World J Lap Surg 2014;7(2):88-91. more complicated surgical procedures and indeed increased
Source of support: Nil surgical costs. 10
Conflict of interest: None Propensity to form adhesions are thought to be patient
specific. The nutritional status, disease entities like diabetes
INTROdUCTION and the presence of concurrent infectious processes also
Abnormal fibrous connections joining tissue surfaces are contribute. They impair leukocyte and fibroblast function
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termed as adhesions. Tissue damage caused by surgical in these patients, potentially increasing adhesion formation.
It has also been shown that postsurgical adhesions increase
with the age of the patient, the number of previous surgeries
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and the type and complexity of surgical procedures. When
1,4,5,7 Associate professor, professor, Assistant professor
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lysed, adhesions have a tremendous propensity to reform.
1-8 department of Obstetrics and Gynecology, MeS Medical
College, perinthalmanna, Kerala, India Since, its first introduction in gynecological surgery in
1986, laparoscopy with its minimal access to the perito­
Corresponding Author: Shyjus puliyathinkal, Associate
professor, department of Obstetrics and Gynecology, 315 neal cavity has been claimed to be associated with reduced
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Sana Apartments, puthanangadi post, Malappuram district rates of adhesion formation and related complications,
Kerala, India, phone: +919747355709, +914933253305 compared with open approach. Conclusive evidence
e-mail: shyjusnair7479@gmail.com
is available from current studies, that a comparable or
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