Prophylaxis of Peritoneal Adhesions: Practical Issues to Consider When Using Antiadhesion Agents

As the most frequent complication of abdominal surgery, peritoneal adhesions produce significant morbidity and an increased risk of vascular, bowel and organ injury in subsequent surgeries. Yet, antiadhesion agents are not routinely used in most abdominopelvic surgeries. We present a review on the safety, efficacy and applicability of available antiadhesion agents to support the surgeons decision making process and to provide an accurate counselling to patients in regard of the type of agent to be used. Searches were conducted in MEDLINE, Pubmed, Wiley Online Library, Directory of Open Access Journals and Orbis. Though singular agents have been subjected to randomized controlled trials, few head-to-head case control studies comparing multiple available and in-research antiadhesion agents have been performed as of yet. Available agents are safe and effective to reduce the incidence of de novo adhesions after abdominopelvic surgery or adhesiolysis (up to 89%), but no single agent is able to fully prevent adhesion formation. The proposed "full conditioning" (86% CO2+ 10% N2O + 4% O2 for the pneumoperitoneum, cooling of the peritoneal cavity, humidification, heparinized rinsing solution and 5 mg of dexamethasone, and hyaluronic acid), showed no adhesion formation (p = 0.0001) in 12/16 women with endometriosis. Surgeons should choose the antiadhesion agent most suitable to the underlying disease, type of surgery and extent of surgical trauma, although no single available agent or surgical strategies can completely prevent adhesions. Guidelines on adhesion prophylaxis are needed. Future research should focus on comparison and combination of available agents.