Journal of the European Society for Gynaecological Endoscopy


Adhesions and Anti-Adhesion Systems Highlights

L.A. Torres-De La Roche 1 , R. Campo 2 , R. Devassy 3 , A. Di Spiezio Sardo 4 , A. Hooker 5 , P. Koninckx 6 , B. Urman 7 , M. Wallwiener 8 , R.L. De Wilde 1

1 University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University Oldenburg, 26121, Germany;
2 Leuven Institute for Fertility and Embryology, Tiensevest, 3000, Leuven;
3 Dubai London Clinic and Speciality Hospital, Dubai, 3371500, UAE;
4 University of Naples Federico II, Napoli, 80131, Italy;
5 Zaans Medical Centre, Zaandam, 1502, Netherlands;
6 UZ Leuven Campus Gasthuisberg, Leuven, 3000, Belgium;
7 Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey, 34330, Turkey;
8 Heidelberg University Women ́s Hospital, Heidelberg, 69115, Germany.


Peritoneal adhesions, prevention, antiadhesion agents, gynecological surgery

Published online: Oct 03 2019


The peritoneal and intrauterine cavities are lined by fragile membranes with a high-wound healing capacity, e.g. repairing the endometrium in its cyclical “injury and scar-free repair process” during menstruation. However, peritoneal and intrauterine fibrosis and adhesions can develop after surgical trauma through activation of molecular, immune and genetic mechanisms. During procedures with a high-risk of adhesions, the use of new peritoneal and intrauterine conditions in combination with anti-adhesion substances are promising measures to preserve peritoneal and endometrial function and avoid the most common complication of gynecological surgery. Highlights of adhesions and anti-adhesion prevention techniques in laparoscopic, laparotomic and hysteroscopic surgeries are discussed in this paper. Unfortunately, evidence is lacking to prove the superiority of one technique over its counterparts in terms of postoperative adhesions, such as instrumentation, type of energy, distending media, and intracavitary pressure. Additionally, there is limited evidence about the efficacy and outcomes of techniques and adjuvant measures used during adhesiolysis. The definition of a universal intrauterine adhesions classification scheme as well as a prognostic scoring system to identify women at high risk of postoperative adhesions are necessary for advising those who could benefit the most of the use of antiadhesion barriers.