Journal of the European Society for Gynaecological Endoscopy


Perspectives in adhesion prevention in gynaecological surgery

L. A. Torres-de la Roche1, U. Catena2, T. J. Clark3,4, R. Devassy1, N. Leyland5, R. L. De Wilde1*

* on behalf of the Special Interest Group Adhesions Research of the European Society for Gynaecological Endoscopy (ESGE)
1 University Hospital for Gynaecology, Pius-Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany;
2 Division of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
3 Department of Obstetrics and Gynaecology, Birmingham Women’s Hospital, Mindelsohn Way, Birmingham B15 2TG, UK
4 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
5 Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada


Adhesion prevention, adhesion barriers, haemostats, surgical technique

Published online: Dec 13 2023


Adhesions are a frequent, clinically relevant, and often costly complication of surgery that can develop in any body location regardless of the type of surgical procedure. Adhesions result from surgical trauma inducing inflammatory and coagulation processes and to date cannot be entirely prevented. However, the extent of adhesion formation can be reduced by using good surgical technique and the use of anti-inflammatory drugs, haemostats, and barrier agents. Strategies are needed in the short-, medium- and longer-term to improve the prevention of adhesions. In the short-term, efforts are needed to increase the awareness amongst surgeons and patients about the potential risks and burden of surgically induced adhesions. To aid this in the medium- term, a risk score to identify patients at high risk of adhesion formation is being developed and validated. Furthermore, available potentially preventive measures need to be highlighted. Both clinical and health economic evaluations need to be undertaken to support the broad adoption of such measures. In the longer- term, a greater understanding of the pathogenic processes leading to the formation of adhesions is needed to help identify effective, future treatments to reliably prevent adhesions from forming and lyse existing ones.