Journal of the European Society for Gynaecological Endoscopy


Postoperative Peritoneal Granulomatous Inflammation After the Application of Potato Starch-Based Anti-Adhesive Agent in Laparoscopic Endometriosis Surgery

H. Krentel1, A. Naem1,2, A. Tannapfel3, R. Devassy4, A.S. Constantin5, R.L. De Wilde6

1 Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, Duisburg Germany
2 Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
3 Department of Pathology, Ruhr University Bochum, Bochum, Germany
4 Dr. Rajesh Devassy’s Centre of Excellence in Gynecological Minimal Access Surgery and Oncology, Dubai London Clinic & Specialty Hospital, Dubai, United Arab Emirates
5 Department of Obstetrics and Gynecology, Albertinen Hospital, Hamburg, Germany
6 Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany


Adhesions, Adhesiogenesis, Endometriosis, Anti-Adhesive Agents, Inflammation, Granulomatosis

Published online: Dec 13 2023


Background: Endometriosis is a chronic inflammatory oestrogen-dependent disease. It is characterised by elevated inflammatory markers in the peritoneal milieu with subsequent adhesiogenesis. Nowadays, excisional, and ablative surgeries are considered the main treatment of endometriosis, and adhesiolysis is being performed almost routinely during these procedures. Postoperative adhesion formation is a significant concern for many surgeons, especially as endometriosis patients are assumed to be predisposed to adhesiogenesis. In order to minimise adhesiogenesis after endometriosis surgery, the usage of different barrier methods have been discussed in the literature. Recent studies aim to investigate the effect of potato starch preparations on adhesion formation in endometriosis patients.

Objectives: We aim to describe the findings of a second-look laparoscopy on patients who received a starch-based anti-adhesive agent.

Materials and Methods: We present a retrospective case series that included the medical, surgical, and histopathologic data of three patients.

Main Outcome Measures: Intraperitoneal adhesion formation and peritoneal inflammation.

Results: All three patients had de-novo adhesions during the second-look laparoscopy. Pathological examination revealed noncaseating granulomatosis of the peritoneum in all patients.

Conclusion: The use of potato starch-based agents as a peritoneal adhesion prophylaxis in laparoscopic endometriosis surgery could lead to granulomatous peritoneal inflammation. Correct application by avoiding powder remnants through complete rinsing and transformation to gel seems to be an important factor to avoid this adverse effect.

What is new? We aim to highlight that potato starch-based anti-adhesive agents similar to the one used in this study could be a cause of adhesiogenesis and peritoneal inflammation.