{"paper_id":"59d433d1-a6e7-423e-a18a-14f1763c6f77","body_text":"Abstract\nPostoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent. Surgeons should adopt a routine adhesion reduction strategy with good surgical technique. Anti-adhesion agents are an additional option, especially in procedures with a high risk of adhesion formation, such as ovarian, endometriosis and tubal surgery and myomectomy. We conclude that good surgical practice is paramount to reduce adhesion formation and that anti-adhesion agents may contribute to adhesion prevention in certain cases.\nSimilar content being viewed by others\nPostoperative adhesions—fibrous connections developing between tissues and organs as a sequel to surgical trauma—have become the commonest complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences.\nOnly a few specialists are aware of the extent of the adhesions problem. Adhesions are a complication of surgery and the problems they are causing can be severe. The lack of awareness about adhesions and adhesion-related disease makes many doctors unable to take care, insurance companies unwilling to pay, and patients left with their complaints.\nRegarding the fact that nearly every abdominal surgery causes adhesions, bowel obstructions due to the adhesions can cause death and many patients have persistent pain, dyspareunia, infertility or bowel complaints after operations, it is amazing that there is such a lack of interest and scientific investigations.\nAdhesiolysis, the most common treatment of postoperative adhesions, is too often followed by adhesion reformation. To ensure that their patients receive the best standard of care and avoid adhesion-related litigation claims, surgeons should routinely adopt effective measures to prevent postoperative adhesions.\nSeveral consensus statements on adhesion prevention give similar recommendations based on available evidence [1–5]. However, the format of these academic documents may be less practical for the busy gynaecological surgeon.\nThe proposed guideline is the beginning of a major concept and work in order to enhance the awareness of adhesions in general, make the scientific research grow and at the end reduce the adhesion-related disease in our patients.\nThis “field guideline” written by a panel of European Experts aims to provide surgeons with a quick reference guide to adhesion prevention adapted to the conditions of their daily practice. Postoperative adhesions—fibrous connections developing between tissues and organs as a sequel to surgical trauma—have become the commonest complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences.\nOnly a few specialists are aware of the extent of the adhesions problem. Adhesions are a complication of surgery and the problems they are causing can be severe. The lack of awareness about adhesions and adhesion related disease makes many doctors unable to take care, insurance companies unwilling to pay, and patients left with their complaints [6, 7].\nRegarding the fact that nearly every abdominal surgery causes adhesions, bowel obstructions due to the adhesions can cause death and many patients have persistent pain, dyspareunia, infertility or bowel complaints after operations, it is amazing that there is such a lack of interest and scientific investigations.\nAdhesiolysis, the most common treatment of postoperative adhesions, is too often followed by adhesion reformation. To ensure that their patients receive the best standard of care and avoid adhesion-related litigation claims, surgeons should routinely adopt effective measures to prevent postoperative adhesions.\nSeveral consensus statements on adhesion prevention give similar recommendations based on available evidence [1–5]. However, the format of these academic documents may be less practical for the busy gynaecological surgeon.\nThe proposed guideline is the beginning of a major concept and work in order to enhance the awareness of adhesions in general, make the scientific research grow and at the end reduce the adhesion related disease in our patients.\nThis “field guideline” written by a panel of European Experts aims to provide surgeons with a quick reference guide to adhesion prevention adapted to the conditions of their daily practice.\nWhat you should know about postoperative adhesions and their consequences\nAdhesions have become the most frequent complications of abdominal surgery—93 % of patients undergoing any abdominal/pelvic surgery are affected [5]—and an important source of postoperative problems\n-\nThe overall risk of adhesion-related readmission following either laparoscopic or open surgery is comparable [8]\n-\nOver one third of patients who undergo extensive open surgery seem to be readmitted with adhesion-related complications within 10 years [9]\n-\nAdhesions are involved in 56 % of reintervention complications [10]\n-\nSeventy-four percent of cases of bowel obstruction are due to post-surgical adhesions [11]\n-\nAdhesions are associated with a marked risk of enterotomy jeopardising 19 % and 10–25 % of patients undergoing open and laparoscopic surgery, respectively [12, 13]\n-\nAdhesions are responsible for 20–40 % of secondary infertility cases in women [14, 15]\nIn addition, adhesions generate a high number of reinterventions, increase hospital stays, extend reintervention times and can make it impossible to apply minimally invasive surgery. Last but not least, managing adhesions and their related complications impose an enormous economic burden. In the UK, the cost of adhesion-related readmissions was estimated at £24.2 and £95.2 million at 2 and 5 years after surgery, respectively [16]\nThe six basic rules of postoperative adhesion prevention in gynaecological surgery [2]\n-\n1.\nThe risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining his/her informed consent\n-\n2.\nSurgeons need to act to reduce postoperative adhesions in order to fulfill their duty of care towards patients undergoing abdominal surgery\n-\n3.\nSurgeons should adopt a routine adhesion reduction strategy at least for patients undergoing high-risk surgery, including:\n-\n(a)\nOvarian surgery\n-\n(b)\nEndometriosis surgery\n-\n(c)\nTubal surgery\n-\n(d)\nMyomectomy\n-\n(e)\nAdhesiolysis\n-\n(a)\n-\n4.\nGood surgical technique is fundamental to any adhesion reduction strategy\n-\n(a)\nCarefully handle tissue with field enhancement (magnification) techniques\n-\n(b)\nFocus on planned surgery and, if any secondary pathology is identified, question the risk: benefit ratio of surgical treatment before proceeding\n-\n(c)\nPerform diligent haemostasis and ensure diligent use of cautery\n-\n(d)\nReduce cautery time and frequency and aspirate aerosolised tissue following cautery\n-\n(e)\nExcise tissue—reduce fulguration\n-\n(f)\nReduce duration of surgery\n-\n(g)\nReduce pressure and duration of pneumoperitoneum in laparoscopic surgery\n-\n(h)\nReduce risk of infection\n-\n(i)\nReduce drying of tissues\n-\n(j)\nUse frequent irrigation and aspiration in laparoscopic and laparotomic surgery when needed\n-\n(k)\nLimit use of sutures and choose fine non-reactive sutures\n-\n(l)\nAvoid foreign bodies when possible—such as materials with loose fibres\n-\n(m)\nAvoid non-peritonised implants and meshes\n-\n(n)\nMinimal use of dry towels or sponges in laparotomy\n-\n(o)\nUse starch- and latex-free gloves in laparotomy\n-\n(a)\n-\n5.\nSurgeons should consider the use of adhesion reduction agents as part of the adhesion reduction strategy\n-\n(a)\nGive special consideration to agents with data supporting safety in routine surgery and efficacy in adhesion prevention\n-\n(b)\nPracticality, ease of use, and cost of agents should influence their selection for routine practice\n-\n(a)\n-\n6.\nGood medical practice implies that any serious or frequently occurring risks be discussed before obtaining the patient’s informed consent prior to surgery\nFor women undergoing gynaecological surgery, and particularly those undergoing tubal and ovarian surgery procedures, who wish to conceive, the implementation of good surgical practice, together with the adoption of adhesion-reduction agents, is paramount to reduce adhesion formation. 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Colorectal Dis 4:355–360\nAcknowledgments\nThis publication was supported by an unrestricted educational grant from Nordic Pharma GmbH, Ismaning, Germany.\nDeclaration of interest\nThis publication was supported by an unrestricted educational grant from Nordic Pharma GmbH, Ismaning, Germany.\nOpen Access\nThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.\nAuthor information\nAuthors and Affiliations\nConsortia\nCorresponding author\nRights and permissions\nOpen Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.\nAbout this article\nCite this article\nDe Wilde, R.L., Brölmann, H., Koninckx, P.R. et al. Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecol Surg 9, 365–368 (2012). https://doi.org/10.1007/s10397-012-0764-2\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s10397-012-0764-2","source_license":"CC0","license_restricted":false}