What can be done to aid Adhesion prevention

A great deal of effort has been dedicated to reduce Adhesion formation. A number of steps can be taken to minimize the risk of Adhesions, including good surgical technique.

Techniques to prevent or reduce Adhesion formation these include - Gental use of tissue handling - Use of delicate instruments/microsurgical techniques - Constant irrigation - Meticulous hemostasis - Removal of all foreign materials - Suturing without significant tension - Mecanical barriers to separate raw surfaces.

Surgeons are developing microsurgical techniques that minamize trauma, ischemia, foreign bodies, hemorrhage, raw surfaces and infection to help reduce Adhesion formation.

Trauma - Trauma is frequently a major contributor to the formation of Adhesions. It has been shown that Adhesions that form after surgery are a result of the body's normal healing process. Adhesions frequently develop during the first three to five days after surgery.

Ischemia - Ischemia During surgery, blood flow often must be disrupted by cutting, coagulation or tying of sutures. This disruption can result in ischemia, or lack of blood supply. This can also lead to inflammation and cause Adhesions formation.

Foreign bodies - Foreign bodies can also cause an inflammatory reaction in the body. A foreign body can be suture material, lint from sponges, or talc from surgical gloves. Local cells respond to the foreign body by releasing factors that incite an inflammatory reaction which may result in Adhesion formation.

Hemorrhage - hemorrhage brings blood products into the operating field. The raw surfaces from the operation plus the blood from tissues can enhance the formation of Adhesions.

Infection - Infection from a variety of sources, endometriosis or pelvic inflammatory disease can cause inflammation, which can result in Adhesion formation.

For over 100 years, surgeons have tried to use drugs and other materials to prevent Adhesions from occurring or recurring with little success. Such materials have included animal membranes, gold foils, mineral oil, silk, rubber and Teflon sheets and even the amniotic membranes (membranes which surround an unborn baby). These materials are placed at or near the site of surgery, rather like a wound dressing. Other exotic treatments have included ingesting iron filings and then moving a magnet around on the abdomen to keep the bowel moving and prevent it from sticking. When the tissue has healed, there is no longer a danger of forming Adhesions.

Recently, scientists have been successful in developing effective absorbable Adhesion barriers that protect tissue and dissolve when they are no longer needed. To date, the only products specifically approved by Food and Drug Administration for use in humans are Interceed barrier made by Johnson & Johnson, Seprafilm made by Genzyme Corporation. Interceed barrier has been shown to be efficacious in gynaecological surgery and Seprafilm in certain types of gynaecological and general surgery.

However, the use of Interceed and Seprafilm is still limited for a variety of reasons. They do not prevent Adhesions every time. Furthermore, neither product has been rigorously tested on patients with severe recurrent Adhesions.

Another product produced is Preclude made by W L Gore, is made of Gore-Tex a version of Teflon. It has not been specifically approved to reduce Adhesions although some doctors use it for this purpose. It does not dissolve in the body and many doctors like to perform a subsequent surgery to remove it. Today many surgeons still instil large volumes of crystalloid, or salt (saline) solutions into the abdomen in the belief that these alone will reduce Adhesions. This premise is not supported by clinical data.

Other products are currently undergoing clinical testing such as Adcon P (Gliatech). Repel and Resolve (Life Medical Sciences) and Intergel (formerly Lubricoat) (Life Core Biomedical). These products should be available in the year 2000.

It is important to note that whatever product is used, it must be combined with good surgical technique in which the surgeon handles tissues as delicately as possible, attempting to avoid further trauma (damage) to them. Powder free gloves should be worn at all times. (No longer used)

It is unlikely that any one product will completely prevent Adhesions in all situations. There thus remains a need for an improved product that works in a variety of surgical situations and works on a greater no of patients.

The value of an absorbable Adhesion barrier

The value of an absorbable Adhesion barrier, Interceed, in the prevention of Adhesions Reformation following microsurgical adhesiolysis.

Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, UK.

Objective: To determine whether Interceed, an absorbable Adhesion barrier, confers any additional benefit over conventional microsurgery, including the use of an adjuvant (hydrocortisone), in the prevention of Adhesion reformation after pelvic microsurgery.

Design: A prospective, randomised, controlled study.

Setting: Jessop Hospital for Women, Sheffield, UK.

Subjects: Twenty-eight women who underwent pelvic microsurgery for infertility or for chronic pelvic pain and who had bilateral pelvic Adhesions and deperitonealised areas following adhesiolysis.

Interventions: Following microsurgical adhesiolysis, one side of the pelvis was randomised to have its deperitonealised areas covered with Interceed, whereas the contra lateral side served as the control. A second look laparoscopy was carried out 3 to 14 weeks after microsurgery to evaluate Adhesion reformation.

Main outcome measure: The amount of Adhesion reformation at second look laparoscopy compared with the amount of deperitonealised area exposed following microsurgical adhesiolysis.

Results: The use of Interceed resulted in a significant reduction of Adhesion reformation over and above that achieved by conventional microsurgical techniques with hydrocortisone as an adjuvant.

Conclusion: Interceed, an absorbable Adhesion barrier, is of value in the prevention of adhesion reformation and may be used in conjunction with hydrocortisone instilled intraperitoneally at the conclusion of microsurgery.

Disclaimer

It is not the intention of UKAS to provide specific medical advice, but rather to provide users with information to better understand their diagnosed disorders. UKAS urges you to consult with a fully qualified medical physician.

UKAS will not be responsible for the availability or content of any external sites, nor does UKAS endorse, warrant or guarantee the products, services or information offered at these other Internet sites.