Prevention of adhesion in laparoscopic gynaecological surgery

Adhesions have important consequences for patients, surgeons, and health services. Peritoneal tissue injury can be prevented by using careful surgical techniques. A large number of anti-adhesion products have been used experimentally and clinically to prevent postoperative adhesions. The current author reviewed the surgical literature published about epidemiology, pathogenesis, and various prevention strategies of adhesion formation. Several preventive agents against postoperative peritoneal adhesions have been investigated. Bioresorbable membranes are site-specific anti adhesion products but may be more difficult to use laparoscopically. Liquids and gels have the advantage of more-widespread areas of action and increased ease of use, particularly during laparoscopic operations. Effective pharmacologic agents that can reduce release of pro-inflammatory cytokines or activate peritoneal fibrinolysis are under development. Their results are encouraging but most of them are contradictory. Many modalities are being studied to reduce this risk; despite initial promising results of different measures in postoperative adhesion prevention, none of them have become standard applications. With the current state of knowledge, preclinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies for avoiding postoperative peritoneal adhesions.