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. 2024 Aug;310(2):655-672.
doi: 10.1007/s00404-024-07584-1. Epub 2024 Jun 15.

Prevention of peritoneal adhesions after gynecological surgery: a systematic review

Sebastian D Schaefer  1 , Ibrahim Alkatout  2 , Nadja Dornhoefer  3 , Joerg Herrmann  4 , Ruediger Klapdor  5 , Ivo Meinhold-Heerlein  6 , Jozsef Meszaros  7 , Alexander Mustea  8 , Peter Oppelt  9 , Markus Wallwiener  10 , Bernhard Kraemer  11
Affiliations

Prevention of peritoneal adhesions after gynecological surgery: a systematic review

Sebastian D Schaefer et al. Arch Gynecol Obstet. 2024 Aug.

Abstract

Importance: The formation of adhesions after gynecological surgery not only has detrimental impacts on those affected, including pain, obstruction, and infertility, but also imposes a high economic burden on healthcare systems worldwide.

Objective: The aim of this review was to evaluate the adhesion prevention potential of all currently available adhesion barriers for gynecological surgery.

Evidence acquisition: We systematically searched MEDLINE and CENTRAL databases for randomized controlled trials (RCTs) on the use of adhesion barriers as compared with peritoneal irrigation or no treatment in gynecological surgery. Only RCTs with second-look surgery to evaluate adhesions in the pelvic/abdominal (but not intrauterine) cavity were included.

Results: We included 45 RCTs with a total of 4,120 patients examining a total of 10 unique types of barriers in second-look gynecological surgery. While RCTs on oxidized regenerated cellulose (significant improvement in 6 of 14 trials), polyethylene glycol with/without other agents (4/10), hyaluronic acid and hyaluronate + carboxymethylcellulose (7/10), icodextrin (1/3), dextran (0/3), fibrin-containing agents (1/2), expanded polytetrafluoroethylene (1/1), N,O-carboxymethylchitosan (0/1), and modified starch (1/1) overall showed inconsistent findings, results for expanded polytetrafluoroethylene, hyaluronic acid, and modified starch yielded the greatest improvements regarding adhesion reduction at 75%, 0-67%, and 85%, respectively.

Conclusions and relevance: Best results for adhesion prevention were reported after applying Gore-Tex Surgical Membrane, hyaluronic acid, and 4DryField®. As Gore-Tex Surgical Membrane is nonabsorbable, it is associated with a greater risk of new adhesion formation due to second-look surgery to remove the product. 4DryField® yielded the greatest improvement in adhesion score compared to all other barrier agents (85%). For better comparability, future studies should use standardized scores and put more emphasis on patient-reported outcome measures, such as pain and infertility.

Keywords: Adhesion barrier; Adhesion prevention; Pelvic pain; Peritoneal adhesions; Second-look surgery.

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Conflict of interest statement

This study was made possible by an unrestricted educational grant from PlantTec Medical GmbH (Lueneburg, Germany). The company had no influence on the authors or results; medical writing and editing were supported by co.medical (Berlin, Germany). The authors declare the following disclosures. Authors who are not listed separately below have no disclosures to declare. SS: royalties from PlantTec Medical GmbH, Baxter, and Eisei; member of advisory board of German working group on gynecological endoscopy (AGE); and vice president of German working group on endometriosis (AGEM). IMH: royalties from PlantTec, Tesaro/GSK, MSD, and Roche and unrestricted research grants from Gedeon Richter, Bayer, Jenapharm, Takeda, and Storz. AM: royalties from PlantTec Medical GmbH, GSK, MSD, Novartis, Olympus, and Stryker. BK: royalties from PlantTec, Baxter, and Medtronic and member of the advisory board of the German working group on gynecological endoscopy (AGE) and the European Society of Gynecological Endoscopy (ESGE).

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram
See this image and copyright information in PMC

References

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