Advanced Surgery Adhesion Prevention

Bis zu 100 % aller Patientinnen entwickeln nach gynäkologischen Eingriffen Verwachsungen*

Verwachsungen sind eine der Hauptursachen für Dünndarmverschluss und Unfruchtbarkeit. Sie können zu chronischen Schmerzen führen und erschweren zukünftige Operationen³

Adhäsionen sind die Hauptursache für sekundäre Unfruchtbarkeit bei Frauen (20%-40%)²⁷

Schützen Sie die Zukunft Ihrer Patienten - Schützen Sie Ihre Patienten vor Verwachsungen

It’s the little things that make a big difference.
Protect your patients’ future

Adhesions are not preventable by surgical technique alone…

Get a copy with the latest insights and publications on adhesion reduction in gynaecological surgery

Minimize adhesions and protect your patients’ future

Perform meticulous hemostasis and irrigate to avoid blood depots¹⁷
Minimize operating time¹⁷
Reduce trauma or damage to the serosa¹⁷
Reduce the risk of infection¹⁷
Reduce tissue drying¹⁷

Frequently irrigate and aspirate during surgery³³
Minimize Use of foreign bodies (i.e. meshes or suture material)¹⁷
Preferably use powder-free gloves in laparotomy¹⁷
Keep the tissue humidified by using humidified gases^17,19
Preferably use microinvasive techniques but there is no consensus in the literature as to whether laparoscopy is associated with fewer de novo and recurring adhesions than laparotomy^2,17,18,32
Use of Adhesion Barriers¹⁷

Pathogenesis of Adhesions and the Risk of Complications

Adhesions are a complication from surgery with consequences that can have lifelong risks^29-30

Learn more

Reduce and Prevent Adhesions

Adhesions are a frequent complication of pelvic surgery and, their reduction or prevention should be the primary goal of every surgeon.

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It is not possible to predict which patients might develop adhesions, so we need to work in order to identify possible predicting factors.

Prof. Giovanni Scambia, “The art of preventing adhesions in Surgery”, Baxter Advanced Surgery HemoVision webinars, June 2021.

References

Becker JM, Dayton MT, Fazio VW, et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg. 1996;183(4):297-306.
Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl. 1990;72(1):60-63.
Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg HR, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010;107(44):769-775. doi:10.3238/arztebl.2010.0769
Diamond MP. Seprafilm Adhesion Study Group. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Fertil Steril. 1996;66(6):904-910.
Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG. Adhesion Study Group Steering Committee; A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003 Oct;46(10):1310-9.
Fazio VW, Cohen Z, Fleshman JW, et al. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006 Jan;49(1):1-11.
Tang C-L, Seow-Choen F, Fook-Chong S, Eu K-W. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum 2003;46:1200–1207
Kusunoki et al. 2005 Masato Kusunoki1, Hiroki Ikeuchi2, Hidenori Yanagi2, Masafumi Noda2, Hitoshi Tonouchi1,Yasuhiko Mohri1, Keiichi Uchida1, Yasuhiro Inoue1, Minako Kobayashi1, Chikao Miki1, and Takehira Yamamura2 Bioresorbable Hyaluronate-Carboxymethylcellulose Membrane (Seprafilm) in Surgery for Rectal Carcinoma: A Prospective Randomized Clinical Trial Surg Today (2005) 35:940–945
Attard, Jo-Anne et al. “Adhesive small bowel obstruction: epidemiology, biology and prevention.” Canadian Journal of Surgery. 2007 Aug; 50(4); 291-300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386166/
Fushiki, H, Tomomi Ikoma, Hiroto Kobayashi, Hideo Yoshimoto. Efficacy of Seprafilm as an adhesion prevention barrier in Cesarean Sections.OB-GYN Surgery.Obstretic and Gynecological Treatment (Japanese publication). 91(5):557-561, Special Edition 2005 November.
Catena, F., De Simone, B., Coccolini, F. et al. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg 14, 20 (2019). https://doi.org/10.1186/s13017-019-0240-7
Nahirniak P, Tuma F. Adhesiolysis. [Updated 2020 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563219/
Fushiki H, Yuki H, Nakajima A. Usefulness of Seprafilm during a cesarean section. Ob Gyn Surgery [Japanese]. 2002:99-105.
Bates GW Jr, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol. 2011 Dec;205(6 Suppl):S19-24. doi: 10.1016/j.ajog.2011.09.030. Epub 2011 Oct 6. PMID: 22114994.
Shunichiro Tsuji, Kentaro Takahashi, Hiroko Yomo, Mutsuko Fujiwara, Nobuyuki Kita, Koichi Takebayashi, Kohji Miyazaki, Yoichi Noda, Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 123, Issue 2, 2005, Pages 244-248, ISSN 0301-2115, https://doi.org/10.1016/j.ejogrb.2005.04.012.
Robertson D, Lefebvre G; CLINICAL PRACTICE GYNAECOLOGY COMMITTEE. Adhesion prevention in gynaecological surgery. J Obstet Gynaecol Can. 2010 Jun;32(6):598-602. English, French. doi: 10.1016/S1701-2163(16)34530-3. PMID: 20569542.
Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg H-R, Hackethal A: Intra-abdominal adhesions—definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int 2010; 107(44): 769–75. DOI: 10.3238/arztebl.2010.0769
Gutt CN; Oniu T; Schemmer P; Mehrabi A; Buchler MW: Fewer adhesions induced by laparoscopic surgery? Surg Endosc 2004; 18: 898–906.
Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B: Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intraabdominal adhesions during prolonged laparoscopic insufflations. J Surg Res 2009; 151: 40–47.
Fruin AB, Bishop-Bartolomei KK, et al.: Neurokinin-1 receptor and substance P messenger RNA levels increase during intraabdominal adhesion formation. J Surg Res 2002; 108: 165–72.
Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL: Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg 2001, 18: 260–73.
Cheong YC, Laird SM, Li TC, Shelton JB, Ledger WL, Cooke ID: Peritoneal healing and adhesion formation/reformation. Human Reprod Update 2001; 7: 556–66.
Monk BJ, Berman ML, Montz FJ: Adhesions after extensive gynecologic surgery: clinical significance, etiology and prevention. Am J Obstet Gynecol 1994; 170: 1396–1403.
Pittaway DE, Daniell JF, Maxson WS: Ovarian surgery in an infertility patient as an indication for a short-interval second-look laparoscopy: a preliminary study. Fertil Steril 1985; 44: 611–14.
Hackethal A, Sick C, Brueggmann D, Tchartchian G, Wallwiener M, Muenstedt K, Tinneberg HR. Awareness and perception of intra-abdominal adhesions and related consequences: survey of gynaecologists in German hospitals. Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):180-9. doi: 10.1016/j.ejogrb.2010.02.017. Epub 2010 Mar 16. PMID: 20236750.
DiZerega GS: Biochemical events in peritoneal tissue repair. Eur J Surg Suppl. 1997; 577: 10–16.
Howard FM: The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14: 467–94.
Stovall TG, Elder RF, Ling FW: Predictors of pelvic adhesions. J Reprod Med 1989; 34: 345–8.
Peters AA, Van den Tillaart SA. The difficult patient in gastroenterology: chronic pelvic pain, adhesions, and sub occlusive episodes. Best Pract Res Clin Gastroenterol. 2007;21(3):445-463. doi:10.1016/j.bpg.2007.01.005;
ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ.
Sarah e. Herrick, Judith e. Allen Surgical adhesions: A sticky macrophage problem, Science05 mar 2021 : 993-994
Lower AM, Hawthorn RJS, Clark D, Boyd JH, Finlayson AR, Knight AD et al (2004) Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24,046 patients. Hum Reprod 19:1877–1885
DeWilde RL, Trew G, on behalf of the Expert Adhesions Working Party of the European Society of Gynaecological Endoscopy (ESGE): Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2 – steps to reduce adhesions. Gynecol Surg 2007; 4: 243–53.
Diamond MP, Freeman ML (2001) Clinical implications of postsurgical adhesions. Hum Reprod Update 7:567–576
ten Broek RP, Bakkum EA, Laarhoven CJ, van Goor H. Epidemiology and Prevention of Postsurgical Adhesions Revisited. Ann Surg. 2016 Jan;263(1):12-9. doi: 10.1097/SLA.0000000000001286. PMID: 26135678.
Herrick SE, Allen JE. Surgical adhesions: A sticky macrophage problem. Science. 2021 Mar 5;371(6533):993-994. doi: 10.1126/science.abg5416. PMID: 33674481.

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It’s the little things that make a big difference.
Protect your patients’ future

Adhesions are not preventable by surgical technique alone…

Get a copy with the latest insights and publications on adhesion reduction in gynaecological surgery

Minimize adhesions and protect your patients’ future

Pathogenesis of Adhesions and the Risk of Complications

Reduce and Prevent Adhesions

It’s the little things that make a big difference. Protect your patients’ future

Adhesions are not preventable by surgical technique alone…

Get a copy with the latest insights and publications on adhesion reduction in gynaecological surgery

Minimize adhesions and protect your patients’ future

Pathogenesis of Adhesions and the Risk of Complications

Reduce and Prevent Adhesions

It’s the little things that make a big difference.
Protect your patients’ future