{"paper_id":"5333749b-16db-46ec-820a-e3b45477920f","body_text":"Vol.:(0123456789)1 3\nh\nttps://doi.org/10.1007/s00423-021-02247-0\nFOR DEBATE\nPostsurgical adhesion formation score pitfalls in endometriosis \nsurgery\nOspan A. Mynbaev1,2 · Amirkhan K. Baimaganbetov1 · Michael Stark1,3\nReceived: 31 May 2021 / Accepted: 13 June 2021 \n© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021, corrected publication 2021\nDear Editor,\nWe read with great attention the well-designed randomized \narticle by Kramer et al. which was published in your jour -\nnal [1]. This study reports the advantages of the adhesion \nbarrier 4DryField® PH in patients following endometrio-\nsis surgery. The severity and extent of adhesions, as well \nas the incidence of the adhesion formation based on the \nnumber of affected sites, were significantly reduced after \nthe application of the adhesion barrier when compared to \nthe control group. It is well-known that the main concern \nin endometriosis surgery is the extension and severity of \nendometriosis involving the uterine wall, ovaries, and sur -\nrounding area, cul-de-sac bladder, ureter, sigmoid (colon), \nand the pelvic wall with deeply located nodes [2 ]. The \npostsurgical adhesion parameters (incidence, extension, \nand severity) after surgery depend on the extension and the \nseverity of the endometriosis. The authors presented endo-\nmetriosis scores in two classification systems (Table 1): \nthe rASRM [3 ] and ENZIAN [4 ]. Both did not show \nsignificant differences among the groups, although the \nENZIAN score demonstrated higher percentages of uter -\nine adenomyosis (FA) and deeply infiltrated bladder endo-\nmetriosis (FB) in the control group (respectively 22% vs \n35% and 13% vs 26%). Subsequently, surgical procedures \nin these locations might result in more adhesions which \ncould increase the incidence, extension, and severity of the \ncondition. The amounts of the barrier components varied \nwidely with the range of powder (1–5 g) and saline solu-\ntion (2–20 ml) showing differences in their application \nareas after surgery. In parallel, the amount of saline ranged \nhighly (5–200 ml), showing that the endometriosis surgi-\ncal procedures were performed with varied extensions. \nTherefore, post-surgical adhesions occurring in many sites \nin one patient with severely traumatic surgery could pro-\nduce misleading results. We believe that the patients were \nrandomized blindly using the MS Excel RAND and this \nmisleading situation certainly was not the intention of the \nauthors. It might show the number of patients with and \nwithout post-surgical adhesions and also adhesion scores \ndepending on the severely traumatic surgical procedures \nwith excision of the deep endometrial nodes. The study \ndesign of postsurgical adhesion formation should take \ninto account the character of the surgical pathology which \nmight produce possible methodological shortcomings in \nthe adhesion score since there are significantly different \nadhesion formation abilities of visceral and parietal tissues \n[5], depending on single or combined traumatic surgical \nprocedures during the same operation [6 ].\nReferences\n 1. Krämer B, Andress J, Neis F, Hoffmann S, Brucker S, Kommoss \nS, Höller A (2021) A\ndhesion prevention after endometriosis \nsurgery - results of a randomized, controlled clinical trial with \nsecond-look laparoscopy. Langenbecks Arch Surg. https://\n doi. or\ng/ \n10. 1007/ s00423- 021- 02193-x\n 2. Koninc\nkx PR, Ussia A, Adamyan L, Wattiez A, Donnez J (2012) \nDeep endometriosis: definition, diagnosis, and treatment. Fertil \nSteril 98(3):564–571. https://\n doi. or\ng/ 10. 1016/j. f\nertn s\ntert. 2012. 07. \n1061\n 3. The American F\nertility Society (1988) The American Fertility \nSociety classifications of adnexal adhesions, distal tubal occlu-\nsion, tubal occlusion secondary to tubal ligation, tubal pregnan-\ncies, Mullerian anomalies and intrauterine adhesions. Fertil Steril \n49(6):944–955\n 4. Tuttlies F\n, Keckstein J, Ulrich U, Possover M, Schweppe KW, \nWustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, \n * Ospan A. Mynbae v \n ospanm\nynbaev@gmail.com\n1 Department of Traumatology, Orthopedics and Oncology, \nKhoja \nAkhmet Yassawi International Kazakh-Turkish \nUniversity, Bekzat Sattarkhanov Avenue, 29, Turkistan, \nKazakhstan\n2 Moscow Institute of Physics and Technology, National \nR\nesearch University, Dolgoprudny, Moscow region, Russia\n3 New Europen Surgical Academy, Berlin, Germany\n/ Published online: 21 June 2021\nLangenbeck’s Archives of Surgery (2021) 406:2145–2146\n\n1 3\nMasetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, \nSillem M, Terruhn V, Tinneberg HR (2005) ENZIAN-Score, eine \nKlassifikation der tief infiltrierenden Endometriose [ENZIAN-\nscore, a classification of deep infiltrating endometriosis]. Zen-\ntralbl Gynakol 127(5):275–81. German. https://\n \ndoi.\n o\nrg/\n \n10. \n1055/s-\n \n2005-\n \n836904\n 5.\n Mynbae\nv OA, Eliseeva MY, Kalzhanov ZR, Lyutova L, Pismen-\nsky SV, Tinelli A, Malvasi A, Kosmas IP (2013) Surgical trauma \nand CO2-insufflation impact on adhesion formation in parietal and \nvisceral peritoneal lesions. Int J Clin Exp Med 6(3):153–165\n 6\n. K\nulakov VI, Adamian LV, Mynbaev OA (1998) Postopera-\ntive adhesions: etiology, pathogenesis and prevention. M: Medi-\ncine [Rus]\nPublisher’s note\n Spr\ninger Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.\n2146 Langenbeck’s Archives of Surgery (2021) 406:2145–2146","source_license":"CC0","license_restricted":false}