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Shyjus Puliyathinkal et al
in patients undergoing laparoscopic surgery for removal tubal occlusion, endometriosis, and/or dermoids. They were
of myomas or endometriotic cysts. The mean number of randomized to receive Oxiplex or no further treatment after
de novo adhesions was 2.58 (2.11) for ADEPT and 2.58 surgery.
(2.38) for LRS. This difference was not found to be signi­ The mean baseline (American Fertility Society adhesion
ficant (Table 3). score) AFS score for each group was 8.0 (Table 6). At second
look, treated adnexa had the same score (8.1), whereas in
Hyaluronic Acid (Intergel)
control adnexa the score increased (8.0­11.6).
The study which investigated the efficacy of this autocross­
16
linked barrier was done in 2006 by Mais et al. Fifty­two CONClUSION
patients aged 22 to 42 years, undergoing surgery at four The decision whether to use an adhesion barrier or not, need
centers, were randomly allocated to receive either the gel to be well thought out one. We need to weigh the balance
or no adhesion prevention. The incidence and severity of between the efficacy of the material used against the cost
postoperative adhesions were assessed laparoscopically after implications involved. The reasonable conclusions that we
12 to 14 weeks in a blinded, scored fashion. were able to reach in the light of the available evidence are
A higher proportion of patients receiving the gel were mentioned below.
free from adhesions compared with control patients. In Oxidized regenerated cellulose (Interceed) effectively
subjects undergoing myomectomy without any concomitant helps to reduce the incidence and extent of postoperative
surgery, though there was no significant difference in the adhesions, even in high risk groups (including patients
proportion of adhesion free patients , a significant difference with severe endometriosis). Though icodextrin (ADEPT)
was found in the mean severity scores (Table 4). In subjects was found to be safe in laparoscopic surgery, no beneficial
without uterine adhesions prior to myomectomy, a significant clinical effects could be established with its use. Auto­cross
diffe rence was found in the severity of uterine adhesions. linked hyaluron gel appears to have a favorable safety profile
as well as an efficacious antiadhesive action following lapa­
Solution of HA (Sepracoat)
roscopic gynecological procedures with the available data.
17
It was the study by Diamond in 1998 which looked at Sepracoat appears to be one of the most promising adhesive
patients who underwent gynecologic procedures by means barriers, in not only being safe but also significantly reducing
of a prospective, randomized, blinded, placebo­controlled the incidence, extent and severity of de novo adhesions at
multicenter study. Surgeons assessed their adhesions during
second­look laparoscopy approximately 40 days later. The Table 4: Mais et al (2006)
Sepracoat group had a significantly lower incidence of Parameter assessed Hyaluron gel No barrier p-value
de novo adhesions than the placebo group as assessed by the percentage of patients free 62% 41% NS
proportion of sites involved and the percentage of patients of adhesions
without de novo adhesions as well as significantly reduced Mean severity scores Less severe < 0.05
for adhesions (for
adhesion extent and severity (Table 5). myomectomy alone)
Mean severity scores for Less severe < 0.05
Oxiplex adhesions (in adhesion
free patients prior to
18
The study of 2005 by Young et al was aimed at patients myomectomy)
undergoing laparoscopic surgery with pelvic adhesions, NS: Nonsignificant

Table 2: Sekiba K (1992) Table 5: diamond (1998)
Parameter assessed Interceed Control p-value Parameter assessed Sepracoat Placebo p-value
percentage of patients 41% 76% < 0.0001 percentage of 13% 4.6% < 0.05
with adhesions adhesion free patients
Area involved in Significantly NA < 0.001 proportion of sites 0.23 0.30 < 0.05
adhesions less involved
percentage of patients 50% 82% < 0.05 Adhesion severity Significantly < 0.05
with adhesions in high less
risk group
Table 6: Young et al (2005)
Table 3: Trew et al (2011) Parameter assessed Oxiplex Placebo p-value
Parameter assessed Icodextrin Ringer’s lactate p-value Increase in AFS score 8-8.1 8-11.6
Mean number of 2.58 (2.11) 2.58 (2.38) 0.909 percentage of patients with 34% 67%
de novo adhesions increase in AFS score
90