<![CDATA[Objective: To know the modalities used for prevention of adhesion
formation in operative laparoscopy.
Method: Literature study.
Results: Methods of prevention of adhesion in laparoscopy include:
modification of surgical technique, anti-inflammatory agents,
peritoneal instillates and barrier adjuvants. Modification of surgical
techniques such as adherence to basic principles of microsurgery,
the use of electrothermal bipolar vessel sealer, liberal irigation of
the abdominal cavity and instillation of a large amount of Ringerâs
lactate at the completion of the procedure. This technique alone,
eventhough seems effective, is insufficient. The anti-inflammatory
agents used are the NSAIDs, corticosteroids, antihistamines, progestogens, GnRH agonists and calcium channel blocker. But none
of them demonstrated to be significantly effective. Barrier adjuvants
consist of: oxidized regenerated cellulose (ORC) and expanded polytetrafluoroethylene (ePTFE) and peritoneal instillates are the crystalloids, icodextrin, hyaluronic acid (HA), solution of HA, viscoelastic gel, hydrogel, and fibrin sealent. There is insufficient evidence data regarding the methods above for the prevention of adhesiogenesis in laparoscopy. But one study evaluating the use of viscoelastic gel did significantly reduce adnexal adhesion in laparoscopy.
Conclusion: Laparoscopy does not trully eliminate the adhesiogenesis
problem. No single therapy is effective for prevention of adhesion
formation. The multimodal methods shall be used to increase
the successful rate in adhesion prevention.
[Indones J Obstet Gynecol 2010; 34-4: 204-7]
Keywords: laparoscopy, adhesion, microsurgery, anti-inflammatory,
peritoneal instillates, barrier adjuvants]]>
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