Adhesion prevention in the surgical treatment of pelvic endometriosis

Objective To review and to discuss the current approaches which may be proposed to prevent adhesions in the surgical management of pelvic endometriosis. Methods The current literature was reviewed using a Medline search and data from the Cochrane Library. Results and conclusions Although not demonstrated in adequately designed prospective randomized trials, laparoscopy is considered to be less adhesiogenic than laparotomy. Adhesion re‐formation is still a major problem after laparoscopy. The use of barrier agents, such as Interceed, or solutions such as Intergel should be considered in patients treated for moderate or severe endometriosis. Although effective, these products are not substitutes for a good surgical technique. As the treatment of adhesions is difficult, every effort should be made to prevent adhesion formation. To prevent severe postoperative adhesion formation, the following rules are proposed. Laparotomy should be avoided whenever possible. When the surgical treatment appears too difficult, a preoperative medical treatment may be used to delay the treatment, to facilitate the procedure, and to avoid a laparotomy. Laparoscopic procedures should be performed according to the principles of microsurgery which have been demonstrated to reduce adhesion formation at laparotomy.