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Review
. 2019 Jun;11(2):137-149.

Adhesions and Anti-Adhesion Systems Highlights

L A Torres-De La Roche  1 , R Campo  2 , R Devassy  3 , A Di Spiezio Sardo  4 , A Hooker  5 , P Koninckx  6 , B Urman  7 , M Wallwiener  8 , R L De Wilde  1
Affiliations
Review

Adhesions and Anti-Adhesion Systems Highlights

L A Torres-De La Roche et al. Facts Views Vis Obgyn. 2019 Jun.

Abstract

The peritoneal and intrauterine cavities are lined by fragile membranes with a high-wound healing capacity, e.g. repairing the endometrium in its cyclical "injury and scar-free repair process" during menstruation. However, peritoneal and intrauterine fibrosis and adhesions can develop after surgical trauma through activation of molecular, immune and genetic mechanisms. During procedures with a high-risk of adhesions, the use of new peritoneal and intrauterine conditions in combination with anti-adhesion substances are promising measures to preserve peritoneal and endometrial function and avoid the most common complication of gynecological surgery. Highlights of adhesions and anti-adhesion prevention techniques in laparoscopic, laparotomic and hysteroscopic surgeries are discussed in this paper. Unfortunately, evidence is lacking to prove the superiority of one technique over its counterparts in terms of postoperative adhesions, such as instrumentation, type of energy, distending media, and intracavitary pressure. Additionally, there is limited evidence about the efficacy and outcomes of techniques and adjuvant measures used during adhesiolysis. The definition of a universal intrauterine adhesions classification scheme as well as a prognostic scoring system to identify women at high risk of postoperative adhesions are necessary for advising those who could benefit the most of the use of antiadhesion barriers.

Keywords: Peritoneal adhesions; antiadhesion agents; gynecological surgery; prevention.

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Figures

Figure 1
Figure 1
— Reproductive outcomes at 12 months after the use of hyaluronic acid gel. Figures show the conception rates after the application of hyaluronic acid gel following dilatation and curettage in women with, at least, one previous curettage. Reproduced with permission from: Hooker AB, de Leeuw R, van de Ven PM, et al. Prevalence of intrauterine adhesions after the application of hyaluronic acid gel following dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial. Hooker et al., 2017.
Figure 2
Figure 2
— Good surgical practice and the use of anti-adhesive barriers. Reproduced with permission from: Wallwiener et al., 2013.
Figure 3
Figure 3
— Strategies for high-risk laparoscopy. Reproduced with permission from: De Wilde et al., 2017.
Figure 4
Figure 4
— Anti-adhesive barriers examples. Reproduced with permission from: Wallwiener et al., 2006.
See this image and copyright information in PMC

References

    1. AAGL. Practice Report: practice guidelines on intrauterine adhesions developed in collaboration with the European Society of Gynaecological Endoscopy (ESGE) J Minim Invasive Gynecol. 2017;24:695–705. - PubMed
    1. Acunzo G, Guida M, Pellicano M, et al. Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a prospective, randomized, controlled study. Hum Reprod. 2003;18:1918–1921. - PubMed
    1. Adoni A, Palti Z, Milwidsky A, et al. The incidence of intrauterine adhesions following spontaneous abortion. Int J Fertil. 1982;27:117–118. - PubMed
    1. AFS. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–955. - PubMed
    1. Ahmad G, Mackie FL, Iles DA, et al. Fluid and pharmacological agents for adhesion prevention after gynecological surgery. Cochrane Database Syst Rev. 2014;9:CD001298 - PubMed

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