Adhesion Prevention in Endometriosis: A Neglected Critical Challenge

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Abstract

Prevention of adhesions, whether de novo or by re-formation, is one of the most important and surprisingly neglected aspect of the treatment of endometriosis. Adhesions may cause infertility, dyspareunia, chronic pelvic pain but also intestinal obstruction and complications at subsequent surgery. They may play a role in the development of some forms of the disease such as ovarian endometriomas and possibly also deep invasive nodules. Three randomized controlled trials have been published documenting some partial success with Interceed, Oxiplex/AP gel or Adept solution in reducing adhesions extent at second look laparoscopy performed a few weeks after initial surgery. However, data on relevant long-term outcomes such as fertility, pelvic pain or disease recurrences or other adhesions-related complications is lacking. Noteworthy, endometriosis is a chronic inflammatory disorder and the insult causing adhesions is expected to persist after surgery. Therefore preventing adhesion formation with exclusively agents at the time of surgery may be insufficient. Future studies should focus on a 2-step strategy that includes measures applied at the time of surgery and subsequent administration of agents able to prevent the development of new adhesions.

Original languageEnglish
Pages (from-to)415-421
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Volume19
Issue number4
DOIs
Publication statusPublished - Jul 2012

Keywords

  • Adhesion
  • Endometriosis
  • Prevention

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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