Adhesion prevention in the surgical treatment of pelvic endometriosis

Objective To review and to discuss the current approaches which may be prop osed to prevent adhesions in the surgical management of pelvic endometriosi s. 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 pr ospective randomized trials, laparoscopy is considered to be less adhesioge nic than laparotomy. Adhesion re-formation is still a major problem after l aparoscopy. The use of barrier agents, such as Interceed, or solutions such as Intergel should be considered in patients treated for moderate or sever e endometriosis. Although effective, these products are not substitutes for a good surgical technique. As the treatment of adhesions is difficult, eve ry effort should be made to prevent adhesion formation. To prevent severe p ostoperative adhesion formation, the following rules are proposed. Laparoto my should be avoided whenever possible. When the surgical treatment appears too difficult, a preoperative medical treatment may be used to delay the t reatment, to facilitate the procedure, and to avoid a laparotomy. Laparosco pic procedures should be performed according to the principles of microsurg ery which have been demonstrated to reduce adhesion formation at laparotomy .