ObjectiveTo investigate the effectiveness of 4% icodextrin (Adept®, ML Laboratories PLC, UK) or lactated Ringer’s solution (LRS) when used as an intra-operative irrigant and post-operative instillate for the reduction of post-surgical adhesions.DesignA large, multicenter, randomized, double-blind clinical trial in gynecological laparoscopy conducted in the USA.Materials and methodsPatients (≥18 years) scheduled for laparoscopic adhesiolysis received intra-operative irrigation (≥100 ml/30 min) and post-surgical instillation (1000 ml) of icodextrin (n=227) or LRS (n=222) during surgery. Extent, incidence and severity of adhesions were assessed prior to adhesiolysis and at a second-look laparoscopy 4-8 weeks later, with both procedures being video recorded for blinded assessment. Numbers of adhesion sites at first- and second-look were compared and analyzed using ANCOVA, and the number of patients with absence of de novo adhesions analyzed using ANOVA.ResultsThere were significantly (p=0.039) fewer sites with adhesions at second-look for icodextrin treated patients compared with the LRS group. Mean ± sd number of sites with adhesions at first surgery was 10.2±4.3 for icodextrin and 10.3±4.5 for LRS. Second-look data were 7.6±4.6 for icodextrin and 8.3±5.0 for LRS. A total of 53% of icodextrin treated patients were free of de novo adhesions compared with 43% of LRS treated patients (p=0.029).ConclusionFollowing laparoscopic adhesiolysis, intra-operative irrigation and post-surgical instillation of 4% icodextrin significantly reduced adhesion formation compared to LRS. ObjectiveTo investigate the effectiveness of 4% icodextrin (Adept®, ML Laboratories PLC, UK) or lactated Ringer’s solution (LRS) when used as an intra-operative irrigant and post-operative instillate for the reduction of post-surgical adhesions. To investigate the effectiveness of 4% icodextrin (Adept®, ML Laboratories PLC, UK) or lactated Ringer’s solution (LRS) when used as an intra-operative irrigant and post-operative instillate for the reduction of post-surgical adhesions. DesignA large, multicenter, randomized, double-blind clinical trial in gynecological laparoscopy conducted in the USA. A large, multicenter, randomized, double-blind clinical trial in gynecological laparoscopy conducted in the USA. Materials and methodsPatients (≥18 years) scheduled for laparoscopic adhesiolysis received intra-operative irrigation (≥100 ml/30 min) and post-surgical instillation (1000 ml) of icodextrin (n=227) or LRS (n=222) during surgery. Extent, incidence and severity of adhesions were assessed prior to adhesiolysis and at a second-look laparoscopy 4-8 weeks later, with both procedures being video recorded for blinded assessment. Numbers of adhesion sites at first- and second-look were compared and analyzed using ANCOVA, and the number of patients with absence of de novo adhesions analyzed using ANOVA. Patients (≥18 years) scheduled for laparoscopic adhesiolysis received intra-operative irrigation (≥100 ml/30 min) and post-surgical instillation (1000 ml) of icodextrin (n=227) or LRS (n=222) during surgery. Extent, incidence and severity of adhesions were assessed prior to adhesiolysis and at a second-look laparoscopy 4-8 weeks later, with both procedures being video recorded for blinded assessment. Numbers of adhesion sites at first- and second-look were compared and analyzed using ANCOVA, and the number of patients with absence of de novo adhesions analyzed using ANOVA. ResultsThere were significantly (p=0.039) fewer sites with adhesions at second-look for icodextrin treated patients compared with the LRS group. Mean ± sd number of sites with adhesions at first surgery was 10.2±4.3 for icodextrin and 10.3±4.5 for LRS. Second-look data were 7.6±4.6 for icodextrin and 8.3±5.0 for LRS. A total of 53% of icodextrin treated patients were free of de novo adhesions compared with 43% of LRS treated patients (p=0.029). There were significantly (p=0.039) fewer sites with adhesions at second-look for icodextrin treated patients compared with the LRS group. Mean ± sd number of sites with adhesions at first surgery was 10.2±4.3 for icodextrin and 10.3±4.5 for LRS. Second-look data were 7.6±4.6 for icodextrin and 8.3±5.0 for LRS. A total of 53% of icodextrin treated patients were free of de novo adhesions compared with 43% of LRS treated patients (p=0.029). ConclusionFollowing laparoscopic adhesiolysis, intra-operative irrigation and post-surgical instillation of 4% icodextrin significantly reduced adhesion formation compared to LRS. Following laparoscopic adhesiolysis, intra-operative irrigation and post-surgical instillation of 4% icodextrin significantly reduced adhesion formation compared to LRS.