Page 9 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):7-12
Clinical Evaluation for Reduction of Adhesions by a Viscoelastic Gel in gynecological Laparoscopic Surgery
Clinical Evaluation for Reduction of Adhesions

by a Viscoelastic Gel in Gynecological

Laparoscopic Surgery

Cyriac Pappachan
Department of Obstetrics and Gynecology, Life Line Hospital, ADOOR, Pathanamthitta, Kerala, India

Abstract The study was conducted in 4 centers in Europe. It was
In laparoscopy, the usual adhesion prevention techniques cannot be randomized, third party blinded and parallel group design. At
applied or are difficult to use. As a result, a viscoelastic gel was each study center, a relevant committee approved the study
developed. plan for human evaluation. Patients included were of 18-46 years
Methods: In third party-blinded, randomized, four center studies, old and willing to undergo a second look of laparoscopy after
patients from 18-46 years underwent surgical laparoscopy in which 6-10 weeks as part of the treatment plan after their initial surgery.
adnexa and adjacent tissues were coated with viscoelastic gel. They The patients included received either Oxiplex/AP Gel to prevent
underwent for a second look 6-10 weeks later. Adhesion scores of the adhesion, or no additional therapy after surgery (control).
American fertility society were quantified with the blinded reviews of Patients excluded were (a) With either history of diabetes,
videotapes.
hepatic or renal disorders.(b) With pelvic or abdominal
Result: For 25 patients, surgery was done on 45 adnexa .Surgical sites infection.(c) Those who received systemic corticosteroids within
with risk of adhesion was covered with approximately 15 ml of 30 days of the initial surgery or postoperative hydrotubation.(d)
viscoelastic gel in approximately 90 seconds. For 24 control patients, If any adhesion preventive adjuvant such as seprafilm, intergel,
surgery alone was done on 41 adnexa. Decrease in AFS score
(11.9-9.1) was seen in treated adnexa. In control adnexa increase in interceed or spray gel, or peritoneal instillates containing non
AFS score (8.8-15.8) seen. The difference (42% reduction) seen in steroidal anti-inflammatory agents, corticosteroids, Hyskon, or
second look AFS score is significant (p < 0.01). any absorbable hemostat.(e) If pregnant, ectopic pregnancy or
Conclusion: Laparoscopic administration of viscoelastic gel was easy reversal of surgical sterilizations.(f) No evidence of endo-
and had significant reduction in adnexal adhesions. The patients metriosis or any adnexal diseases.(g) Bowel perforation or
undergoing gynecological surgeries were benefited. conversion to laparotomy.
Keywords: Laparoscopy, viscoelastic gel, adnexal adhesions, adhesion INTRODUCTION
prevention, Oxiplex/AP Gel.
In conservative gynecological surgeries, the use of adhesion
AIMS AND OBJECTIVES preventive adjuvant has become significant. Increased rates
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of reoperation, chronic pelvic pain, postoperative bowel
The aim of this study was to compare the effectiveness and 4
safety of viscoelastic gel as an adhesion preventive device. obstruction and infertility are the clinical consequences of
The following parameters such as safety, complications, adverse adhesions after peritoneal cavity surgery. This markedly
events and time for administration were evaluated. increases health care costs. This makes adhesion prevention, a
major contributor in the outcome of a successful surgery.
As early as 1990, adhesion preventive adjuvant was available
MATERIAL AND METHODS
for gynecologists. Gynecare, USA produced interceed
A literature search was performed using medline and the search absorbable adhesion barrier. This was followed by site specific
engine Google, Springer link and Highwire press. The following barriers like Preclude (Gore-Tex, USA) and Seprafilm
search terms were used: Laparoscopy, Adhesion, Viscoelastic bioabsorbable membrane (Genzyme, USA). It was challenging
gel and Oxiplex. Selected papers were screened for further to use these first generation adhesion preventive devices
references. Criteria for selection of literature were the number of commonly used in laparotomy to be used in laparoscopy. In
cases (excluded if less than 20), methods of analysis (statistical 2001 food and drugs agency (FDA) approved Integral adhesion
or nonstatistical) and operative procedure (only universally prevention solution to be used for laparotomy. Many
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accepted procedures were selected). gynecologists found that integral administration was easy in

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