• Prevention of Post-operative intra-abdominal adhesions: A review study
  • Farshid Davoodi,1,* Shayan Taheri,2 Nima Nezhadi,3
    1. Student of Veterinary Medicine, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
    2. Student of Veterinary Medicine, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
    3. Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran


  • Introduction: The main unpleasant consequence of pelvic surgeries is the formation of adhesion bands. Visceral peritoneum in the uterus, ovaries, uterine tubules and intestine tends to form adhesion bands more than the parietal peritoneum in the pelvic and abdominal wall. This is very important for gynecologists because more than 25 percent of infertility reasons are related to post-operation pelvic adhesions. Post-operative adhesions occur in 50 to 80% of cases of abdominal surgery and 60 to 90% of gynecological surgeries. These adhesions are as a result of incomplete fibrin lysis and cell exudate after peritoneal injury. The mechanism of formation of adhesion bands is that the mechanical, chemical, and infectious agents that damage the peritoneum stimulate different inflammatory cells and tissue damage results in the release of tissue thromboplastin and activation of the coagulation cascade, which results in activation of thrombin. Activated thrombin converts fibrinogen to fibrin, which precipitates on the peritoneal surface. When platelets and fibrin come in contact with the bare basement membrane, fibrin polymerization occurs. The most common outcomes of peritoneal adhesions include small bowel obstruction, infertility, chronic abdominal, and pelvic pain and difficulty in recurring surgery. Adhesion bands formation in intestine, especially after hysterectomy surgery is prevalent. Although these bands may not lead to any problems, they are sometimes problematic and can cause intestinal obstruction. Adhesions are one of the most common causes of infertility resulting from surgeries such as uterine tubes surgery and myomectomy. Adhesions between the ovaries, Fallopian tubes or walls of the pelvis can block the path of ovulation from the ovaries into the uterus through the fallopian tubes. The bands around the fallopian tubes also make it difficult or impossible for the sperm to reach the ovum. Adhesion bands are a prevalent cause of pelvic pain. These bands can connect tissues and organs that are naturally separated so that they are tied downwards, and every movement relevant with stretching and pressing stimulates the surrounding nerve tissue and is painful. So preventing abdominal adhesion formation is essential to reduce postoperative complications. In this study, we aimed to investigate the drugs and substrates that were applied in order to avoid postoperative abdominal adhesions.
  • Methods: This review uses keywords related to adhesions, intra-abdominal adhesions, infertility, postoperative adhesions search to obtain results in articles published in Iranian and foreign prestigious journals in SID, Magiran, Scopus, PubMed, Google Scholar, and Elsevier databases. Time interval 2016 up to 2019 was performed.
  • Results: There have been many studies on adhesions, and many drugs have been tested. Here we want to list medicines and chemicals that were used to prevent or reduce adhesions: 1- Fibrin soluble compounds: Fibrinilysin, Streptokinase, Urokinase, Hyaluronidase, Chymotrypsin, Trypsin, and Pepsin. 2- Anticoagulants: Heparin, Citrates, Oxalates 3- Anti-inflammatory: containing corticosteroids, NSAIDs, anti-histamines, progesterone, calcium channel blockers, and colchicine. 4- Anti-biotics: cephalosporins 5- Antioxidants: numerous antioxidants were used untill now. 6- Peritoneal instillates: Crystalloid solutions were the most commonly used instillate in the abdominal cavity after surgery such as Ringer’s lactate, normal saline, and lactated Ringer’s solution. 7- Barriers: endogenous barriers such as amniotic membrane grafts, autologous peritoneal transplants, and exogenous barriers such as 0.5% ferric hyaluronate gel, hyaluronic acid with carboxymethylcellulose (Seprafilm), an adhesion barrier system which consists of two polyethylene glycol-based liquids (SprayGel), Poloxamer 407 (FlowGel), and Polytetrafluoroethylene with trade name of Gore-Tex.
  • Conclusion: In general, postoperative adhesions are one of the complications that always cause irreparable damage, and this is especially important in women's health. Since these adhesions are extremely difficult to treat, prevention is the best option. Researchers are always looking for the best way to prevent these adhesions.
  • Keywords: Adhesions, Intra-abdominal adhesions, Infertility, Surgery