Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

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• 作者：Verguts Jasper ; Bosteels Jan ; Corona Roberta ; Hamerlynck Tjalina…
• 关键词：Adhesion prevention ; Consensus ; Hysteroscopy ; Laparoscopy ; Laparotomy
• 刊名：Gynecological Surgery
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：12
• 期：3
• 页码：179-187
• 全文大小：196 KB
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  12.Rein DT, Schmidt T, Hess AP, Volkmer A, Sch?ndorf T, Breidenbach M (2011) Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol 18(6):774-78PubMed View Article
  13.Hamerlynck TW, Blikkendaal MD, Schoot BC, Hanstede MM, Jansen FW (2013) An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol 20(6):796-02PubMed View Article
  14.Hrazdirova L, Svabik K, Zizka Z, Germanova A, Kuzel D (2012) Should hysteroscopy be provided for patients who have undergone instrumental intrauterine intervention after delivery? Acta Obstet Gynecol Scand 91(4):514-17PubMed View Article
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• 作者单位：Verguts Jasper (1) (2)
  Bosteels Jan (3)
  Corona Roberta (4)
  Hamerlynck Tjalina (5)
  Mestdagh Greet (6)
  Nisolle Michelle (7)
  Puttemans Patrick (8)
  Squifflet Jean-Luc (9)
  Van Herendael Bruno (10)
  Weyers Steven (5)
  
  1. Department of Obstetrics and Gynecology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
  2. UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
  3. Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium
  4. Unit of Reproductive Medicine, Department of Obstetrics and Gynecology, University Hospital Brussels, Brussels, Belgium
  5. Department of Obstetrics and Gynaecology, Ghent University Hospital, Gent, Belgium
  6. Department of Obstetrics and Gynecology, ZOL, Genk, Belgium
  7. Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
  8. Unit of Reproductive Medicine, Leuven Institute for Fertility and Embryology, Heilig Hart Hospital, Leuven, Belgium
  9. Department of Obstetrics and Gynecology, Catholique de Louvain, Woluwe-Saint-Lambert, Belgium
  10. Department of Obstetrics and Gynecology, ZNA Stuivenberg, Antwerp, Belgium
  
• 刊物主题：Gynecology; Minimally Invasive Surgery; Surgical Oncology; Obstetrics/Perinatology; Reproductive Medicine; Interventional Radiology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1613-2084

文摘

Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10?days after adhesiolysis: 2dd two tablets of estradiol 2?mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer’s lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo? or Intercoat?) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.