Summary:
Adhesions means fibrous or scar tissue that results from the
healing process. Up to 95% of patients who have surgery develop
adhesions. Adhesions formation and its long term sequel is a
well known complication of the surgery but unfortunately very
little is investigated about the prevention. The long term
morbidities such as chronic pelvic pain, secondary infertility,
hospital readmission, bowel obstruction, difficult repeat C/S
with increased bleeding, longer operative time, injury to bowel
,bladder, ureters and placental accreta spectrum disorder from
adhesions are the main concern. The cost for these adhesions is
extreme burden for the developing countries.
Several preventive agents against postoperative adhesions
have been investigated. The proper surgical technique
remains the cornerstone for good outcomes and risks
reduction. Careful tissue handling, keeping tissue moist,
meticulous homeostasis, minimization of tissue ishcaemia
and avoiding excessive tissue desiccation, the use of micro
and a traumatic instruments are very important to prevent the
adhesive disorders. Several chemical agents, mechanical
barriers and hydrofloatation are being used which seems to
be promising. But all of them have some limitations. All
these Barriers are being used widely but need to be properly
evaluated, before its routine use. FDA approved Barrier
Seprafilm, Hydrofloation Adept are popular but also CoSeal,
SurgiWrap and Plasmax( not FDA approved ) are getting
much popularity. Oxidized regenerated cellulose is promising
but for C/S is not properly evaluated. The chemical barriers
like NSAID, Steroids, antifibrinolytic agents and
anticoagulant are being used since ancient period but they
are not proved to be superior to adhesive barriers.
In the current state of knowledge, none can replace the good
surgical technique. Therefore along with the training of
appropriate surgical technique, preclinical or clinical studies
are still necessary to evaluate the effectiveness of the several
proposed prevention strategies and more researches are time
demanding to prevent postoperative adhesions.
Key words: Postoperative adhesion, Caesarean section.
(J Bangladesh Coll Phys Surg 2017; 35: 86-90)