Postoperative adhesion prevention a sticky problem

OBJECTIVES: To investigate various agents for adhesion prevention when used as adjuvants during pelvic surgery. SEARCH STRATEGY: The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and SCOPUS. Intra-abdominal adhesions may occur after most surgical procedures, and are of major clinical, social and economic concern. In most instances the adhesions are asymptomatic, but in about 5% they will lead to adhesion-related disorders, such as small bowel obstruction, pelvic pain and infertility. Although minimal access surgery has been shown to be less adhesiogenic than traditional open surgery, with regard to certain procedures, it does not totally eliminate the problem. Consequently, attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures. A wide variety of strategies, including surgical techniques, and the use of pharmacological agents and mechanical barriers have been advocated. There does not seem to be any single modality that has proven to be effective in preventing postoperative adhesion formation following laparoscopic or hysteroscopic surgery. Since meticulous surgical technique alone is insufficient, further research is needed on adjunctive therapies for the prevention and/or reduction of adhesion formation following laparoscopic procedures. This review discusses ways to reduce abdominal adhesions, and provides an update on current practices, and future research regarding experimental and clinical use of various anti-adhesive agents.