Reduction in Adhesive Small-Bowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: laparoscopic ovarian multi-needle intervention. Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models Visceral Sliding Technique Is Useful for Detecting Abdominal Adhesion and Preventing Laparoscopic Surgical Complications Detection of abdominal wall adhesions using visceral slide Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial Gonadotrophin-releasing hormones agonist therapy increases peritoneal fibrinolytic activity and prevents adhesion formation after myomectomy Prevention of Postoperative Abdominal Adhesions by a Novel, Glycerol/Sodium Hyaluronate/Carboxymethylcellulose-Based Bioresorbable Membrane: A Prospective, Randomized, Evaluator-Blinded Multicenter Study Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial. Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model. Silastic Splints Reduce Middle Meatal Adhesions after Endoscopic Sinus Surgery Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. The Efficacy of a Novel Chitosan Gel on Hemostasis and Wound Healing after Endoscopic Sinus Surgery Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Prevention of post-surgical adhesion formation using aspirin in a rodent model: a preliminary report. Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat. Peritoneal nebulizer: a novel technique for delivering intraperitoneal therapeutics in laparoscopic surgery to prevent locoregional recurrence
Introduction Although Seprafilm ® has been demonstrated to reduce adhesion formation , it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction . Methods This was a prospect i ve , r and omized , multicenter , multinational , single-blind , controlled study . This report focuses on those patients who underwent intestinal resection ( n = 1,701 ) . Before closure of the abdomen , patients were r and omized to receive Seprafilm ® or no treatment . Seprafilm ® was applied to adhesiogenic tissues throughout the abdomen . The incidence and type of bowel obstruction was compared between the two groups . Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods . The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years . Results There was no difference between the treatment and control group in overall rate of bowel obstruction . The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm ® patients compared with no-treatment patients : 1.8 vs. 3.4 percent ( P < 0.05 ) . This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent . In addition , a stepwise multivariate analysis indicated that the use of Seprafilm ® was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation . In both groups , 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days . Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up . Conclusions The overall bowel obstruction rate was unchanged ; however , adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm ® , which was the only factor that predicted this outcome BACKGROUND Postoperative abdominal adhesions are associated with numerous complications , including small bowel obstruction , difficult and dangerous reoperations , and infertility . A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane ( HA membrane ) was developed to reduce formation of postoperative adhesions . The objectives of our prospect i ve study were to assess the incidence of adhesions that recurred after a st and ardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions . STUDY DESIGN Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy .  Before abdominal closure , patients were r and omly assigned to receive or not receive HA membrane placed under the midline incision . At ileostomy closure eight to 12 weeks later , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed for 175 assessable patients . While only five ( 6 percent ) of 90 control patients had no adhesions , 43 ( 51 percent ) of 85 patients receiving HA membrane were free of adhesions ( p < 0.00000000001 ) . The mean percent of the incision length involved was 63 percent in the control group , significantly greater than the 23 percent observed in patients who received HA membrane ( p < 0.001 ) . Dense adhesions were observed in 52 ( 58 percent ) of the 90 control patients , but in only 13 ( 15 percent ) of the 85 receiving HA membrane ( P < 0.0001 ) . Comparison of the incidence of specific adverse events between the groups did not identify a difference ( P > 0.05 ) . CONCLUSIONS This study represents the first controlled , prospect i ve evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using st and ardized , direct peritoneal visualization . In this study , HA membrane was safe and significantly reduced the incidence , extent , and severity of postoperative abdominal adhesions Laparoscopic ovarian drilling ( LOD ) is the accepted second-line treatment for clomiphene citrate-resistant anovulatory infertility in polycystic ovary syndrome ( PCOS ) . Although multiple pregnancy rates are reduced with ovarian drilling procedures , postoperative adhesion formation is a potential complication in up to 85 % of the women subjected to laparoscopic destructive ovarian procedures . Our objective was to determine the effectiveness of a new , specially design ed laparoscopic device and technique that might enable treatment for patients with anovulatory PCOS with less trauma and fewer postoperative adhesions . Thirty-five infertile clomiphene citrate-resistant women with PCOS were included . Seventeen women underwent laparoscopic ovarian multi-needle intervention ( LOMNI ) , and 18 women received step-up ovulation induction treatment with recombinant follicle-stimulating hormone followed by intrauterine insemination for three cycles . Patients were followed for a period of 6 months after either laparoscopic surgery or the initiation of ovulation induction therapy . Outcome measures were cycle regularity , pregnancy rate , safety , postoperative adhesion formation , and cost effectiveness . There were no significant differences between the two groups in terms of age , body-mass index , duration of infertility , and basal cycle-day 2 hormone levels . Significant improvement in cycle regularity ( p < .01 ) was found after LOMNI .  Cumulative pregnancy rates ( 35.3 % in the LOMNI group vs 33.3 % in the ovulation induction group ) did not differ between the groups . No adverse events following surgery were noted . Moderate ovarian hyperstimulation syndrome and multiple pregnancies occurred in four and two patients , respectively , in the ovulation induction group . Eight nonpregnant women in the LOMNI group underwent repeat laparoscopy at the end of the follow-up period . No adhesion formation attributable to LOMNI was observed in any of those eight women . The cost of LOMNI was significantly ( p < .001 ) lower than the ovulation induction treatment . In conclusion , LOMNI may be a safe , inexpensive , and effective procedure for the treatment of CC-resistant infertility in patients with PCOS . It seems to preserve the beneficial effects and probably omits unwanted effects ( such as adhesion formation ) of LOD Background The management of small intestinal serosal defects remains controversial . Non-closure of such defects is regarded as a risk factor of fistula formation or intestinal leakage , whereas defect closure with absorbable suture material is potentially associated with adhesion formation . The aim of our pilot study was to evaluate the influence of small intestinal serosal defect closure on peritoneal wound healing , leakage rate , and adhesion formation in a rabbit model . Methods Twenty-two male rabbits were r and omized into two groups . Following median laparotomy , a st and ardized small intestinal serosal defect with a diameter of 1 cm was performed . Either the defect was closed by two seromuscular 4/0 polyglactin single sutures ( n = 11 ) or the defect was left open ( n = 11 ) . On postoperative day 14 , all animals were sacrificed for morphological investigations . Complications and the rate of intestinal leakage were measured . The degree of adhesion formation was measured by computer-assisted planimetry . Results No animal developed fistula formation or intestinal leakage . Eight ( 73 % ) animals of the closure group developed local peritoneal adhesions with a mean size of 39.7 ± 45 mm2 . No animal in the non-closure group revealed local peritoneal adhesions at the defect . However , two ( 18 % ) animals in the non-closure group developed peritoneal adhesions distant to the defect with a mean size of 3.5 ± 9 mm2 . Comparing both groups , the size of peritoneal adhesions was significantly higher in the closure group ( p = 0.013 ) . Conclusions Closure of isolated serosal injuries with resorbable suture material was associated with an adhesion formation in distressing certainty , whereas no leakage or fistula formation could be observed at all . Further studies are needed to clarify the impact of serosal defect closure in particular on leakage rate and fistula formation , e.g. , with pre-existing adhesions , in case of multiple serosal injuries or with a pre-existing peritonitis Study Objective : Introduce a non-invasive method preoperatively to prevent bowel injury by the Veres needle and trocar during laparoscopy . Design : Case-controlled study . Setting : A hospital-based study . Patients : Five hundred and twelve patients who underwent laparoscopic surgery were prospect ively enrolled . Intervention : A simple and non-invasive method to detect bowel adhesions preoperatively . Results : A total of 512 patients who underwent operative laparoscopy  were prospect ively enrolled for ultrasonographic visceral sliding evaluation . They were subdivided into two groups as follows : group I , 332 patients without previous abdominal surgery ; group II , 180 patients with previous abdominal surgery .  No bowel adhesion to the umbilicus was present in group I. In group II , only two cases with bowel adhered to the periumbilical area were found by visceral sliding technique . No patients suffered any bowel injury . Conclusion : The proposed technique is useful and highly effective in guiding the insertion of the Veres needle and trocar to prevent bowel injury in laparoscopy Background Abdominal surgery , peritonitis , and pelvic inflammatory disease often give rise to intra-abdominal adhesions . They may lead to chronic pain , infertility , bowel obstruction , etc . Development in surgical strategies in the last decade has result ed in an increase in laparoscopic procedures and , as a consequence , a steep rise in reported bowel lesions . Accordingly , noninvasive diagnostic tools are desirable to identify adhesions before abdominal surgery . This study was design ed to vali date transabdominal ultrasonography ( TAU ) and magnetic resonance imaging ( cine MRI ) for detection of abdominal wall adhesions . Methods Sixty patients scheduled for laparoscopic surgery were prospect ively enrolled . They were divided into two groups of 30 each ; previous abdominal surgery/peritonitis and no history of abdominal surgery/peritonitis . Before elective surgery , TAU and cine MRI were performed . Visceral slide was measured in nine predefined abdominal segments and compared with intra-operative data on abdominal wall adhesions . Results were obtained in a double-blinded fashion . Results Patient characteristics were similar in both groups . Cine MRI showed a sensitivity , specificity , and accuracy of 21.5 % , 87.1 % , and 72.4 % . TAU showed a sensitivity , specificity , and accuracy of 24 % , 97.9 % , and 81.3 % . Comparison of TAU and cine MRI showed no significant difference in the detection of adhesions to the abdominal wall ; however , TAU was significantly superior in depicting adhesion-free areas . Conclusions This study represents the first comparative study of TAU and cine MRI as noninvasive methods in detecting adhesions to the abdominal wall . Both methods are specific in detecting adhesion-free areas , and may serve as a diagnostic tool for future planning of laparoscopic surgery , elucidation of adhesion-related symptoms , and as a tool in the follow-up after ventral hernia repair with implantation of intraperitoneal mesh Background Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery . It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction . This study was design ed to compare the incidence of bowel obstruction in a r and omized trial where laparoscopic and open resection for colon cancer was compared . Methods A retrospective analysis was performed , collecting data of episodes of bowel obstruction with or without surgery . Only episodes treated in the hospital where the index surgery took place were included . Data for 786 patients were collected for the 5-year period after cancer surgery . Results Baseline characteristics for the evaluated laparoscopic ( n = 383 ) and open ( n = 403 ) groups were comparable . The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1 % respectively and did not significantly differ from each other . Tumor stage seemed to influence the risk for bowel obstruction : 2.8 % in stage I , 6.6 % in stage II , and 7 % in stage III , but the differences were not significant . Conclusions This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery The aim of this study was to evaluate uterine adhesions after  myomectomy  and peritoneal fibrinolytic capacity in women treated with gonadotrophin-releasing hormone agonist ( GnRHa ) before surgery . A prospect i ve observational study comprised 15 infertile women who underwent myomectomy .  Before surgery , 10 were treated with buserelin acetate ( 900 μg/day ) for 10 – 12 weeks followed by additional postoperative treatment with GnRHa for 4 weeks ( GnRHa group ) and five received no treatment ( control group ) . Peritoneal fluid specimens were taken at the beginning of myomectomy and the adhesions were estimated by second-look surgery ( caesarean section or laparoscopy ) . Levels of plasminogen activator ( PA ) and PA inhibitor ( PAI ) were determined by enzyme-immunosorbent assays . Pre- and postoperative GnRHa therapy significantly reduced adhesion formation compared with control groups ( adhesion scores ; 0.2 ± 0.4 vs. 2 ± 1 , P < 0.0001 ) . GnRHa group showed a significant decrease in PAI level ( P < 0.0001 ) but no significant change in PA level , suggesting increased fibrinolytic capacity in peritoneal fluid from GnRHa-treated patients . These data suggest that GnRHa therapy is successful in preventing adhesion formation after myomectomy . GnRHa-induced shift to more fibrinolytic activity , mainly because of a decreased level of PAI , may play a critical role in the mechanism of the GnRHa 's action on postoperative adhesion development INTRODUCTION Postoperative abdominal adhesions are associated with significant morbidity and mortality , placing a substantial burden on healthcare systems worldwide . Development of a bioresorbable membrane containing up to 23 percent glycerol and chemically modified sodium hyaluronate/carboxymethylcellulose offers ease of h and ling and has been shown to provide significant postoperative adhesion prevention in animals . This study was design ed to assess the safety of glycerol hyaluronate/carboxymethylcellulose and to evaluate its efficacy in reducing the incidence , extent , and severity of postoperative adhesion development in surgical patients . METHODS Twelve centers enrolled 120 patients with ulcerative colitis or familial polyposis who were scheduled for a restorative proctocolectomy and ileal pouch-anal anastomosis with diverting loop ileostomy . Before surgical closure , patients were r and omized to no antiadhesion treatment ( control ) or treatment with glycerol hyaluronate/carboxymethylcellulose membrane under the midline incision . At ileostomy closure , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed using the intent-to-treat population . Treatment with glycerol hyaluronate/carboxymethylcellulose result ed in 19 of 58 patients ( 33 percent ) with no adhesions compared with 6 of 60 adhesion-free patients ( 10 percent ) in the no treatment control group ( P = 0.002 ) . The mean extent of postoperative adhesions to the midline incision was significantly lower among patients treated with glycerol hyaluronate/carboxymethylcellulose compared with patients in the control group ( P < 0.001 ) . The severity of postoperative adhesions to the midline incision was significantly less with glycerol hyaluronate/carboxymethylcellulose than with control ( P < 0.001 ) . Adverse events were similar between treatment and no treatment control groups with the exception of abscess and incisional wound complications were more frequently observed with glycerol hyaluronate/carboxymethylcellulose . CONCLUSIONS Glycerol hyaluronate/carboxymethylcellulose was shown to effectively reduce adhesions to the midline incision and adhesions between the omentum and small bowel after abdominal surgery . Safety profiles for the treatment and no treatment control groups were similar with the exception of more infection complications associated with glycerol hyaluronate/carboxymethylcellulose use . Animal models did not predict these complications OBJECTIVE To evaluate the efficacy of an oxidized regenerated cellulose adhesion barrier as an adjuvant in preventing postoperative adhesions in infertile women undergoing reconstructive surgery . STUDY DESIGN Thirty-eight cases of reconstructive surgery that could be followed up for more than two years ( myomectomy 19 , cystectomy 5 , tuboplasty 10 , uteroplasty 4 ) at the Fujita Health University Hospital were evaluated retrospectively . The barrier ( Intercede , Johnson & Johnson ) was used to cover the surgical site in 23 of these cases ( Intercede group ) ; no adjuvant was used in 15 cases , which represent the surgical control group ( Intercede - group ) , including 23 second-look operation cases ( 16 in the Intercede and 7 in the control group ) . Postoperative adhesion prevention and pregnancy rates were estimated . RESULTS At the second-look operation , six cases ( 37.5 % ) in the Intercede + group and six ( 85.7 % ) in the Intercede - group had postoperative adhesions . No significant difference was found in either intensity or area covered with adhesions between the two groups . Eighteen cases ( 78.3 % ) in the Intercede and seven ( 46.7 % ) in the Intercede - group conceived during the follow-up period . CONCLUSION The use of Intercede significantly reduced the rate of postoperative adhesion formation , with a statistically significant increase in the pregnancy rate as compared to the surgical controls OBJECTIVE To determine the frequency of peritoneal and visceral adhesions to the umbilical region according to past surgical history and to estimate the risk of bowel injury with blind insertion of the principal trocar-cannula . DESIGN Prospect i ve , unicentric study by a single operator . SETTING Clinique Saint-Sernin and Polyclinique de Bordeaux , Bordeaux , France . PATIENT(S ) Eight hundred fourteen patients undergoing diagnostic or operative laparoscopy were classified into four groups based on their history of abdominal surgery : group I ( n = 469 ) , no previous abdominal surgery ; group II ( n = 125 ) , prior laparoscopic surgery ; group III ( n = 131 ) , previous laparotomy with a horizontal supra-pubic incision ; group IV ( n = 89 ) , previous laparotomy with a midline incision .  INTERVENTION(S ) Initial microlaparoscopy performed through the left upper quadrant of the abdomen , inspection of the anterior abdominal wall and particularly the umbilical area for the presence of adhesions . Patients who had adhesions were assessed as to whether or not they were at significant risk of injury from blind insertion of the principal trocar . MAIN OUTCOME MEASURE(S ) Incidence of umbilical adhesions and the potential risk of bowel injury with blind  insertion of the umbilical ( principal ) trocar . RESULT ( S ) Umbilical adhesions were found in 9.82 % of the 814 cases . The rates of umbilical adhesions were as follows : group I , 0.68 % ; group II , 1.6 % ; group III , 19.8 % ; and group IV , 51.7 % . Severe adhesions with potential risk of bowel injury with blind insertion of the umbilical trocar in the four groups were 0.42 % , 0.80 % , 6.87 % , and 31.46 % , respectively . CONCLUSION ( S ) Women with previous laparotomy have a higher incidence of umbilical adhesions , especially in case of midline incision . Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended for patients at risk for adhesions to reduce complications associated with insertion of the principal ( umbilical ) trocar OBJECTIVE To study the role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery . STUDY DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care referral centre . PATIENTS Thirty patients were selected suffering long-term problems with bilateral chronic rhinosinusitis , with no relief obtained from medical therapy . Patients requiring revision sinus surgery or having acute upper respiratory tract infection were excluded . INTERVENTIONS Diagnostic nasal endoscopies and non-contrast computerized tomography of nose and paranasal sinuses were undertaken and , following confirmation of the diagnosis , functional endoscopic sinus surgery ( FESS ) was carried out bilaterally using the Messerklinger technique . On completion of the surgery , a cotton wick soaked in mitomycin C was placed in one or other side of the nose in the middle meatus . Follow up was for three months and patients were assessed for subjective and objective improvement in their symptoms . RESULTS Post-operatively , of the 11 ( 36.6 per cent ) patients complaining of persistent nasal obstruction , nine had complaints limited to the control side only ( p=0.005 ) . Out of the nine ( 30 per cent ) patients complaining of recurrent nasal discharge , eight had complaints on the control side and only one reported discharge from both sides ( p=0.006 ) . CONCLUSION Mitomycin C may be topically applied in post-operative FESS cases to reduce adhesion formation and hence the need for revision surgery Viscera slide is the normal , longitudinal movement of the intraabdominal viscera caused by respiratory excursions of the diaphragm . By detecting areas of restricted viscera slide , ultrasonic imaging was used to identify anterior abdominal wall adhesions prior to laparotomy or laparoscopy . Transcutaneous ultrasound examination was performed on 110 patients . A prediction of adhesions was made for each patient and then compared to the findings during subsequent laparotomy or laparoscopy .  Only patients with previous abdominal surgery or history of peritonitis demonstrated adhesions . Sensitivity and specificity of viscera slide ultrasound in predicting adhesions were 90 % and 92 % . Nine out of 10 false results involved misinterpretation of ultrasound images of the lower one-third of the abdomen . Ultrasonic imaging of viscera slide is highly accurate in detecting abdominal wall adhesions . This technique is most useful in guiding the insertion of trocar in laparoscopic surgery , and as a noninvasive method in study ing the formation of adhesions OBJECTIVE To determine if 3 months of preoperative gonadotropin-releasing hormone agonist ( GnRH-a ) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids . DESIGN Prospect i ve , r and omized , clinical study . SETTING A tertiary care medical center . PATIENT(S ) Women of reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal . INTERVENTION(S ) Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy  for evaluating uterine adhesions after r and om allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery . MAIN OUTCOME MEASURE(S ) Adhesion formation between treatment groups and by incision number and aggregate length . RESULT ( S ) Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo . For every additional centimeter of incision length , the total adhesion area over the uterine serosal surface increased by 0.55 cm(2 ) . The number of myomas removed and the number of incisions were positively correlated with total adhesion area . CONCLUSION ( S ) Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions . Following the st and ards of good surgical technique , adhesions are minimized with fewer and smaller incisions OBJECTIVE Our purpose was to compare postoperative adhesion formation and reproductive outcome after the same ovarian surgical procedure performed by laparoscopy or laparotomy by means of microsurgical techniques . STUDY DESIGN Twenty-eight New Zeal and White female rabbits were r and omly assigned to laparotomy or laparoscopy for the same st and ardized surgical procedure : both ovaries were grasped with atraumatic forceps and longitudinally incised on the antimesenteric side from the cortex to the hilum with a microelectrode delivering a tissue power density of 66,666 W/cm . The rabbits were then mated , and 2 weeks later a second-look laparotomy was performed by a blinded observer for the evaluation of postoperative adhesions , number of corpora lutea in each ovary , number of embryos in the ipsilateral uterine horn , and nidation index for each side . RESULTS At second look no statistically significant differences were found in postoperative adhesion formation , number of corpora lutea , number of embryos , and nidation index between the laparoscopy and the laparotomy groups . CONCLUSION Laparoscopy or laparotomy for ovarian conservative surgery do not appear significantly different in postoperative adhesion formation and reproductive outcome in the rabbit model Background Adhesions frequently form between the middle turbinate and lateral nasal wall after  endoscopic sinus surgery ( ESS ) and are a possible cause for surgical failure . Many absorbable and nonabsorbable spacers have been tried to improve healing . This study was design ed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase . Methods Forty-two patients who were scheduled to undergo ESS for chronic rhinosinusitis were r and omized to have a silastic splint placed into the middle meatus on one side of the nose but not the other at the completion of surgery . Splints were removed 2 weeks postoperatively . Symptom scores were recorded for each side of the nose up to 12 weeks after surgery and ethmoid cavities were grade d at the 6- and 12-week visits along with assessment of adhesions . Patients were blinded to which side was splinted as was the surgeon assessing ethmoid cavities at 6 and 12 weeks . Results Thirty-three patients completed 12 weeks of follow-up . Nasal obstruction and facial pain/discomfort were significantly higher on splinted sides for the first 2 weeks . More interventions were performed to debride adhesions in nonsplinted sides . Endoscopy revealed no adhesions at 12 weeks for sides treated with a splint whereas 9 of 33 nonsplinted sides had persistent adhesions . There were no significant differences in symptom or ethmoid cavity scores at 6 or 12 weeks between sides treated with splints versus sides treated without splints or between sides with adhesions versus without adhesions . Conclusion Middle meatal silastic splints reduce adhesions after ESS but increase early nasal obstruction and discomfort . Their use did not significantly change symptom or ethmoid cavity scores at 12 weeks STUDY OBJECTIVE To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation  after ovarian surgery with those of conventional operative laparoscopy . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING Teaching hospital . PATIENTS Eighteen women with polycystic ovary disease . INTERVENTIONS Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries . MEASUREMENTS AND MAIN RESULTS Approximately 10 to 12 coagulation points were applied to each ovary . Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups . The frequency of adhesion formation and changes in glutathione peroxidase ( GSH-Px ) , superoxide dismutase ( SOD ) , catalase ( CAT ) , and glutathione ( GSH ) levels were studied in homogenized peritoneal tissues obtained during surgery in each group . RESULTS Clinical profiles were similar between groups . Mean exposure , amount , and pressure of CO2 were significantly less in the microlaparoscopy group ( p < 0.05 ) . The laparoscopy group had significantly more adhesions than the microlaproscopy group ( 24 % vs 48 % , p < 0.05 ) . The GSH-Px , SOD , CAT , and GSH levels were significantly lower in the laparoscopy group ( 0 . 425 micromol , 1.2 ng , 37.55 micromol , and 0.9 nmol vs 0.755 micromol , 2.l ng , 625 micromol , and 2.6 nmol , respectively ) . CONCLUSION Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy . This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems , which are proposed mechanisms for adhesion formation and closely related to peritoneal injury . In addition , microlaparoscopy may be a cost-effective alternative to conventional laparoscopy . ( J Am Assoc Gynecol Laparosc 6(2):159 - 163 , 1999 Background Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery ( ESS ) . Continued bleeding risks airway compromise from the inhalation of blood clots and from the aspiration of blood-stained vomitus . Additionally , adhesion formation is the most common reason for patients requiring revision surgery . This study aim ed to determine the efficacy of a novel chitosan/dextran ( CD ) gel on hemostasis and wound healing after ESS . Methods A r and omized controlled trial was performed involving 40 patients undergoing ESS for chronic rhinosinusitis . Immediately after surgery a baseline Boezaart Surgical Field Grading Scale was taken . Computer r and omization was performed with one side receiving CD gel and the other side receiving no treatment ( control ) . Boezaart bleeding scores were then calculated for each side every 2 minutes . Patient 's endoscopic features of wound healing were assessed at 2 , 6 , and 12 weeks after surgery . Results CD gel  achieved rapid hemostasis with the mean time to hemostasis at 2 minutes ( 95 % CI , 2–4 minutes ) compared with 10 minutes ( 95 % CI , ≥6 minutes ) for the control ( p < 0.001 ) . There were significantly less adhesions at all time points with CD gel versus control : 2 versus 18 at 2 weeks ( p < 0.001 ) , 3 versus 16 at 6 weeks ( p < 0.001 ) , and 2 versus 12 at 3 months ( p < 0.001 ) . There was no significant difference between CD gel and control with respect to crusting , mucosal edema , infection , or granulation tissue formation . Conclusions CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation , addressing two of the most common complications of sinus surgery BACKGROUND A prospect i ve , r and omized , controlled study was performed to assess the efficacy of auto-crosslinked hyaluronic acid ( ACP ) gel to prevent the development of de-novo intrauterine adhesions following hysteroscopic surgery . METHODS One hundred and thirty-two patients with a single surgically remediable intrauterine lesion ( myomas , polyps and uterine septa , subgroups I-III ) completed the study . Patients were r and omized to two different groups : group A underwent hysteroscopic surgery plus intrauterine application of ACP gel ( 10 ml ) while group B underwent hysteroscopic surgery alone ( control group ) . The rate of adhesion formation and the adhesion score was calculated for each group and subgroup 3 months after surgery . RESULTS Group A showed a significant reduction in the development of de-novo intrauterine adhesions at 3 months follow-up in comparison with the control group . Furthermore , the staging of adhesions showed a significant decrease in adhesion severity in patients treated with ACP gel . CONCLUSIONS ACP gel significantly reduces the incidence and severity of de-novo formation of intrauterine adhesions after hysteroscopic surgery OBJECTIVE To assess adhesion formation after laparoscopic ovarian cautery in women with polycystic ovarian syndrome ( PCOS ) and the efficacy of Interceed Adhesion Barrier ( Ethicon , Summerville , NJ ) in their prevention . DESIGN Prospect i ve , r and omized , blinded , clinical study of laparoscopic ovarian cautery with application of Interceed to one ovary , followed by short interval second-look laparoscopy , scoring of adhesions , and clinical follow-up . SETTING Tertiary care clinic at a University teaching hospital . PATIENTS Eight infertile women with PCOS who failed to conceive with previous clomiphene citrate ( CC ) therapy .  RESULTS Periovarian adhesions of varying severity developed in all women after laparoscopic ovarian cautery . Interceed showed no protective effect . Despite this finding , all women initiated regular menses after laparoscopic ovarian cautery and seven of eight women spontaneously conceived eight singleton pregnancies without any further therapy . CONCLUSION Laparoscopic ovarian cautery should be considered in infertile women with PCOS who fail to respond to CC therapy . These women must be counseled with respect to the possible complication of postoperative adhesion formation Pelvic adhesions are one of the major factors which significantly and adversely affect surgery outcome due to intra- and postoperative morbidity and reduce future female fertility . Using a rodent model , we evaluated the efficacy of aspirin , a non-steroidal anti-inflammatory drug , in the prevention of adhesion formation . A total of 72 female Wistar rats received a st and ardized primary traumatic lesion to the right uterine horn . They were r and omly divided into eight groups : group I ( control ) had no treatment and group II received a single pre-operative 0.70 mg aspirin . All the succeeding groups ( III-VIII ) received aspirin in doses of 0.35 , 0.70 , or 1.40 mg every 6 h for either 48 or 96 h in addition to the pre-operative aspirin ( 0.70 mg ) . All animals were killed 4 weeks later and adhesions were assessed using a modified adhesion scoring scale . The lowest adhesion score was found in the group treated with 0.35 mg of aspirin for 96 h , and the highest was found among the groups treated with either 0.70 or 1.40 mg for 48 - 96 h respectively ( P < 0.05 ) . These results are in line with the hypothesis that administration of a low dose of aspirin selectively inhibits the production of thromboxane A2 , whereas basal prostacyclin bio synthesis is preserved . This phenomenon might contribute to reducing postoperative adhesion formation in a rat model . Thus , future studies into the prevention of adhesion formation may require the additional use of a non-steroidal anti-inflammatory drug , for which aspirin deserves further attention , before extrapolation into human therapy OBJECTIVE To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat . METHODS In this experimental study , 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included . Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy . Afterwards , the rats were r and omly assigned to receive simvastatin ( 30 mg/kg body weight ) as a single intraperitoneal dose at the time of laparotomy ( n=16 ) or normal saline in same volume at the same time ( n=16 ) . At the day 21 , animals were euthanized and the adhesions were quantified clinical ly ( via repeated laparotomy ) and pathologically and compared between the two groups . RESULTS The baseline characteristics of the animals were comparable between two study groups . Clinical ly , in simvastatin group , 10 rats ( 62.5 % ) did not develop any adhesion and 6 ( 37.5 % ) had first- grade adhesion ; whereas in the control group , 11 ( 68.8 % ) rats had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . Pathologically , in simvastatin group , 6 rats ( 37.5 % ) had first- grade adhesion , while in control group , 11 rats ( 68.8 % ) had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . CONCLUSION Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat Background Peritoneal involvement is a significant issue in the treatment of gastrointestinal malignancies . Current statistics indicate that after surgical intervention , up to 20 % of patients will present with locoregional metastasis . The ability to inhibit initial tumor adhesion to the mesothelial lining of the peritoneum may be considered critical in the inhibition of tumor development . This article describes , the use of a novel nebulizer system capable of delivering high-concentration , low-dose therapeutics to the peritoneal cavity . Methods For this study , 30 male WAG rats were inoculated with CC531 colorectal tumor cells . The rats were r and omized into three groups : control group ( n = 10 ) , heparin-treated group ( n = 10 ) , and high-molecular-weight hyaluronan-treated group ( n = 10 ) . A peritoneal cancer index was used to determine tumor burden at 15 days . Analysis of variance ( ANOVA ) was used to compare multiple group means . Results Nebulization therapy was performed without any complication in the cohort . Heparin inhibited macroscopic intraperitoneal tumor growth completely ( p = 0.0001 ) without affecting tumor cell viability . The introduction of hyaluronan attenuated both tumor size and distribution , was compared with the control group ( p = 0.002 ) . Conclusion Nebulized heparin and hyaluronic acid using a novel nebulization technique attenuates peritoneal tumor growth after laparoscopic surgery . The technique itself is easy to use and safe
None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction .
None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes , small bowel obstruction and infertility .
The meta- analysis provides little evidence for the surgical principle that using less invasive techniques , introducing less foreign bodies or causing less ischaemia reduces the extent and severity of adhesions
INTRODUCTION Adhesion formation is the most common complication following  peritoneal surgery  and the leading cause of small bowel obstruction , acquired infertility and inadvertent organ injury at reoperation .
Using a ' good surgical technique ' is advocated as a first step in preventing adhesions .
However , the evidence for different surgical techniques to reduce adhesion formation needs confirmation .