Adhesion Prevention

Dr. Brahmana Askandar, dr., SpOG (K)

Divisi Onkologi Ginekologi, Departemen Obstetri Ginekologi, RSU Dr Sutomo / FK Unair,

Surabaya

Adhesion is one of late complication of gynecologic surgery. It is estimated that around

55%-100% woman undergoing pelvic surgery will have adhesion (Liakakos et al., 2001).
Common consequences of adhesion caused by pelvic and abdominal surgery are : pelvic and
abdominal pain, bowel obstruction, infertility, difficulties in resurgery etc. The adhesions may
not have a flare up until months or even years later. Adhesions can be difficult to diagnose, it is
more likely that a definitive diagnosis of adhesions is made during surgical exploration , can be
achieved by diagnostic laparoscopy or laparotomy.

Because diagnosis and treatment is not simple and patient can suffer from chronic
complain, it is important to prevent adhesion when we are doing gynecologic surgery. Adhesion
may be caused by ischaemia process or inflammatory process. Ischaemia mechanism during
gynecologic surgery can be occurred when tissues are crushed, sutured, or ligated.
Contamination of the peritoneal can also create an adhesion through an inflammatory process,
peritoneal cavity can be contaminated by suture material, talcum powder, blood and faecal
material. To prevent adhesion , a meticulous and gentle surgical procedures must be done during
surgery and minimal tissue trauma also have to be obtained. The use of barrier agents in
adhesion prevention is developing nowadays, a synthetic barrier agents may reduce the incidence
of adhesion but other concern is arrised, they also could cause an inflammatory reaction.

The most important factor in adhesion prevention is : tissue handling to prevent

ischaemia, and contamination control to prevent inflammatory process. Adhesion barrier could
be considered for patients who are at high risk of forming clinically significant adhesions such as
patients with endometriosis or pelvic inflammatory disease or patient with fibroid who is
undergoing myomectomy