Prevention of peritoneal adhesions after gynecological surgery: a systematic review.

Autor: Schaefer SD; Department of Gynecology and Obstetrics, Clemenshospital Muenster, Münster, Germany. seb.schaefer@alexianer.de., Alkatout I; Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Kiel, Germany., Dornhoefer N; Department of Gynecology, University Hospital Leipzig, Leipzig, Germany., Herrmann J; Department of Gynecology and Obstetrics, Weimar Hospital, Weimar, Germany., Klapdor R; Department of Gynecology and Obstetrics, Albertinen Hospital Hamburg, Hamburg, Germany., Meinhold-Heerlein I; Department of Gynecology and Obstetrics, University Hospital Giessen, Giessen, Germany., Meszaros J; Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital Magdeburg, Magdeburg, Germany., Mustea A; Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Bonn, Germany., Oppelt P; Department of Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University, Kepler University Hospital Linz, Linz, Austria., Wallwiener M; Department of Gynecology and Obstetrics, University Hospital Halle, Halle, Germany., Kraemer B; Department of Women's Health, University Hospital Tuebingen, Tübingen, Germany.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2024 Aug; Vol. 310 (2), pp. 655-672. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1007/s00404-024-07584-1
Abstrakt: Importance: The formation of adhesions after gynecological surgery not only has detrimental impacts on those affected, including pain, obstruction, and infertility, but also imposes a high economic burden on healthcare systems worldwide.
Objective: The aim of this review was to evaluate the adhesion prevention potential of all currently available adhesion barriers for gynecological surgery.
Evidence Acquisition: We systematically searched MEDLINE and CENTRAL databases for randomized controlled trials (RCTs) on the use of adhesion barriers as compared with peritoneal irrigation or no treatment in gynecological surgery. Only RCTs with second-look surgery to evaluate adhesions in the pelvic/abdominal (but not intrauterine) cavity were included.
Results: We included 45 RCTs with a total of 4,120 patients examining a total of 10 unique types of barriers in second-look gynecological surgery. While RCTs on oxidized regenerated cellulose (significant improvement in 6 of 14 trials), polyethylene glycol with/without other agents (4/10), hyaluronic acid and hyaluronate + carboxymethylcellulose (7/10), icodextrin (1/3), dextran (0/3), fibrin-containing agents (1/2), expanded polytetrafluoroethylene (1/1), N,O-carboxymethylchitosan (0/1), and modified starch (1/1) overall showed inconsistent findings, results for expanded polytetrafluoroethylene, hyaluronic acid, and modified starch yielded the greatest improvements regarding adhesion reduction at 75%, 0-67%, and 85%, respectively.
Conclusions and Relevance: Best results for adhesion prevention were reported after applying Gore-Tex Surgical Membrane, hyaluronic acid, and 4DryField ® . As Gore-Tex Surgical Membrane is nonabsorbable, it is associated with a greater risk of new adhesion formation due to second-look surgery to remove the product. 4DryField ® yielded the greatest improvement in adhesion score compared to all other barrier agents (85%). For better comparability, future studies should use standardized scores and put more emphasis on patient-reported outcome measures, such as pain and infertility.
(© 2024. The Author(s).)
Databáze: MEDLINE
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