Adhesions and their consequences have long concerned surgeons. Prevention of adhesions relies on good surgical technique – optimal haemostasis, minimising  tissue trauma, avoidance of necrosis and use of excessive electrodiathermy, avoidance of spillage of contaminants eg. bowel, dermoid contents and the preference for MIS techniques rather than laparotomy. The role of bacterial infection following surgery is an obvious and important factor that cannot be underemphasised.

The main gynaecological consequences concerning adhesion prevention that have been evaluated include the desire to improve chronic pelvic pain, infertility and the prevention of bowel obstruction. The use of second-look laparoscopy has been the main tool used to evaluate the short term improvement in adhesion recurrence. This assessment has been problematic because of the diverse causes of adhesions eg. myomectomy, endometriosis, previous pelvic surgery, PID. In addition,  there is no universally accepted best method for classifying adhesions – extent, density, strength of adhesions, plus adjacent organ involvement.

It has been shown that prevention of adhesions can be achieved, but the long term clinical results for pelvic pain, fertility and bowel obstruction prevention cannot be shown confidently. Anti-adhesion products have been around for a long time, but they are still not providing what we desperately want, and that is reliable, predictable adhesion prevention.

The use of anti-adhesion agents has been extensively reviewed in the Cochrane Database¹.

These agents are broadly classified into:

1)      Pharmacological agents eg. heparin, steroids, promethazine

2)      Barrier agents

a.       Liquids and gels eg. Spraygel, Adept, Coseal

b.      Solid agents eg. Interceed, Gore-Tex, Seprafilm

Reference:

1)      Ahmad G, Mackie FL, Iles DA, O’Flynn H, Dias S, Metwally M, Watson A.

Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD001298. DOI:

              10.1002/14651858.CD001298.pub4.