Adhesion prophylaxis in gynecological operations

Abstract

The problem of adhesions represents one of the major causes for postoperative complications. Specially after certain gynecological operations like endometriosis or removal of uterine fibroids, the formation of adhesions is very common and can lead to pain and/or sterility. Beside good surgical technique to avoid peritoneal damage, the use of barrier methods can reduce this relevant problem. With SprayGel® (polyethylene glycol [PEG]) and Adept® solution (4% icodextrin), two products are available for use at the end of surgery in selected cases with high risk for postoperative adhesions. Until now, we have used these barrier methods in 319 patients (SprayGel®, n=126; Adept® solution, n=193) without any postoperative complications. Main indications were extensive adhesiolysis, severe endometriosis and removal of large uterine fibroids. In 177 patients, we could perform a second look laparoscopy (SLL) 4–6 weeks following primary surgery (SprayGel®, n=102; Adept® solution, n=75). The findings showed overall good results with no clinical side effects. Especially in patients after adhesiolysis, we could experience a significant reduction of incidence and extent of adhesions at second look laparoscopy. The specific advantages of both methods allow the individual selection of SprayGel® and Adept® solution. This can lead to an improvement of the operative results in respect to adhesion related problems like bowel obstruction, pain and sterility.