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Cited by 32Intestinal and Peritoneal AdhesionsGynecological conditions and treatmentsHernia repair and management

Prevention of peritoneal adhesions after gynecological surgery: A systematic review

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Schaefer, Sebastian D., Alkatout, Ibrahim, Dornhoefer, Nadja, Herrmann, Joerg, Klapdor, Ruediger, Meinhold-Heerlein, Ivo, Meszaros, Jozsef, Mustea, Alexander +3 more·2024·Archives of Gynecology and Obstetrics
DOI 10.1007/s00404-024-07584-1PMC PMC11258159
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Abstract

Importance: The formation of adhesions after gynecological surgery not only has detrimental impacts on those affected, including pain, obstruction, and infertility, but also imposes a high economic burden on healthcare systems worldwide. Objective: The aim of this review was to evaluate the adhesion prevention potential of all currently available adhesion barriers for gynecological surgery. Evidence acquisition: We systematically searched MEDLINE and CENTRAL databases for randomized controlled trials (RCTs) on the use of adhesion barriers as compared with peritoneal irrigation or no treatment in gynecological surgery. Only RCTs with second-look surgery to evaluate adhesions in the pelvic/abdominal (but not intrauterine) cavity were included. Results: We included 45 RCTs with a total of 4,120 patients examining a total of 10 unique types of barriers in second-look gynecological surgery. While RCTs on oxidized regenerated cellulose (significant improvement in 6 of 14 trials), polyethylene glycol with/without other agents (4/10), hyaluronic acid and hyaluronate + carboxymethylcellulose (7/10), icodextrin (1/3), dextran (0/3), fibrin-containing agents (1/2), expanded polytetrafluoroethylene (1/1), N,O-carboxymethylchitosan (0/1), and modified starch (1/1) overall showed inconsistent findings, results for expanded polytetrafluoroethylene, hyaluronic acid, and modified starch yielded the greatest improvements regarding adhesion reduction at 75%, 0–67%, and 85%, respectively. Conclusions and relevance: Best results for adhesion prevention were reported after applying Gore-Tex Surgical Membrane, hyaluronic acid, and 4DryField ® . As Gore-Tex Surgical Membrane is nonabsorbable, it is associated with a greater risk of new adhesion formation due to second-look surgery to remove the product. 4DryField ® yielded the greatest improvement in adhesion score compared to all other barrier agents (85%). For better comparability, future studies should use standardized scores and put more emphasis on patient-reported outcome measures, such as pain and infertility.

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  • Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction.

    “Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction.”

    From Biomaterials in Postoperative Adhesion Barriers and Uterine Tissue Engineering (2025) · cites this paper as [3]

  • In gynecological surgery, adhesion formation often leads to chronic pelvic pain, bowel obstruction, and infertility.

    “In gynecological surgery, adhesion formation is of particular concern, as it often leads to chronic pelvic pain, bowel obstruction, and infertility [3].”

    From Biomaterials in Postoperative Adhesion Barriers and Uterine Tissue Engineering (2025) · cites this paper as [3]

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Authors
Schaefer, S. D., Alkatout, I., Dornhoefer, N., Herrmann, J., Klapdor, R., Meinhold-Heerlein, I., Meszaros, J., Mustea, A., Oppelt, P., Wallwiener, M., & Kraemer, B.
Affiliations
  • Clemenshospital Münster (DE)
  • Sophien-und Hufeland Klinikum (DE)
  • Albertinen Diakoniewerk (DE)
  • Universitätsklinikum Gießen und Marburg (DE)
  • University Hospital Magdeburg (DE)
  • University Hospital Bonn (DE)
  • Johannes Kepler University of Linz (AT)
  • University Hospital in Halle (DE)
  • Universitätsklinikum Tübingen (DE)
Corresponding author
Schaefer, Sebastian D.
ORCID
Venue
Archives of Gynecology and Obstetrics
Publisher
Springer Science and Business Media LLC
Published
2024-06-15
Volume
310
Issue
2
Pages
655-672
ISSN
  • 0003-9128 (ISSN-L)
  • 1432-0711
DOI
10.1007/s00404-024-07584-1
PMC
PMC11258159
OpenAlex
W4399700701
Cited by
32
References
1
Citations by year
2026: 19 · 2025: 10 · 2024: 3
FWCI
3.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Archives of Gynecology and Obstetrics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PUBLISSO (German National Library of Medicine) (submittedVersion, cc-by)
Funders
PlantTec Medical GmbH (unrestricted educational grant)
Topics
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Surgery › Hernia repair and management
Keywords
peritoneal adhesions, adhesion prevention, anti-adhesion barrier, gynecologic surgery, second-look surgery, oxidized regenerated cellulose, polyethylene glycol, hyaluronic acid, icodextrin, expanded polytetrafluoroethylene, modified starch, dextran, infertility, postoperative pain
MeSH terms
Tissue Adhesions, Female, Humans, Peritoneal Diseases, Postoperative Complications, Gynecologic Surgical Procedures, Randomized Controlled Trials as Topic, Second-Look Surgery

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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