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Preventing adhesions in laparoscopic surgery: the role of anti‐adhesion agents
Author(s) -
ArefAdib Mehrnoosh,
Phan Timothy,
Ades Alexandre
Publication year - 2019
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1111/tog.12588
Subject(s) - adhesion , medicine , laparoscopic surgery , laparoscopy , bowel obstruction , surgery , intensive care medicine , chemistry , organic chemistry
Key content Surgical injury causes the release of cytokines, growth factors, cell adhesion molecules and histamine, creating an inflammatory response, which can lead to adhesion formation in the peritoneal cavity. Compared with open surgery, laparoscopy reduces the risk of adhesion formation, but the risk is not completely eliminated. Adhesion formation is multifactorial and depends on patient healing, surgical technique and equipment factors. Adhesions after gynaecological surgery can have long‐term consequences including small bowel obstruction, chronic pelvic pain, deep dyspareunia and female subfertility. There are a variety of anti‐adhesion agents with different properties available for use in laparoscopic surgery.Learning objectives To review the pathophysiology of adhesion formation after laparoscopic surgery. To identify which anti‐adhesive agents are currently available in clinical practice. To understand the mechanism by which adhesion prevention agents work. To review the effectiveness and cost implications of anti‐adhesive agents.Ethical issues Given the extra cost of anti‐adhesive agents, and the limited information regarding their efficacy, should surgeons be using them in laparoscopic gynaecological surgery? Is the use of anti‐adhesion agents complementary or detrimental to meticulous surgical technique?