Purpose:

Adhesions are associated to multiple pathologies and are a significant burden to patients, surgeons and the health system, attempts have been made to develop strategies to prevent their occurrence and reformation. Laparoscopy produces less peritoneal trauma than conventional laparotomy and may result in decreased adhesion formation. However, for high-risk laparoscopy, like Endometriosis surgery the outcome of adhesion formation is equal to laparotomy.  Either laparoscopy, pneumoperitoneum modulation nor the wide usage of multiple adhesion prevention agents have changed the situation, so the burden of adhesion prevention still remains the same.  

Our objective was to investigate the role of adhesion prevention agents, surgical strategies and postsurgical procedures to minimize the postoperative re-formation of adhesions. 

Methods:

Since 1991 we have performed more than 1000 cases of severe Adhesion-Related Disorder using Laparoscopy as well as gasless Lift-laparoscopy with the combination of different Adhesion prevention agents (SprayShield™, Adept™), second and third-look laparoscopies. A special postoperative management was introduced into the concept in the last 5 years. 

Results:

The extent, severity and grade of adhesions were reduced with an overall of 83 % comparing to the initial procedure with the results of the second- and third-look  laparoscopy.

Conclusion:

The procedures show a significant reduction of adhesion reformation. Adhesion prevention strategies and procedures supporting the physiological anti-adhesion formation process need to be taken seriously when trying to prevent reformation of adhesions.  We report about 15 years of experience with second- and third-look laparoscopies plus special surgical strategies and perioperative management.  We also discuss the timing of second- and third-look laparoscopies as well as strategies to enhance the physiological ability to prevent adhesion re-formation.