Intra-abdominal adhesions in gynecological surgery

Evangelinakis N, Nikolaou M, Katasos T

Department of Obstetrics and Gynecology, Agios Nikolaos general hospital, Agios Nikolaos, Crete, Greece

Correspondence: Evangelinakis Nikolaos, Department of Obstetrics and Gynecology, Agios Nikolaos general hospital, 1 Knossou St, GR-72100, Agios Nikolaos, Crete, Greece. E-mail:


Intra-pelvic and intra-abdominal adhesions represent the basic causes of obstruction of small bowel, infertility, chronic pain, and impaired organ functioning, whereas they increase the risk of post-operative complications in case of a second surgery. Adhesion formation begins with formation of a fibrin matrix on two opposing injured peritoneal surfaces, which typically occurs during coagulation in the presence of suppressed fibrinolysis. The organ that is most commonly implicated in adhesion formation is the omentum, while small and large intestine and ovaries are also commonly found participating in adhesions. The main approach to prevent the formation of adhesions consists of applying the principles of microsurgery in every step of the surgery, so that injury of peritoneum is the least possible. Secondarily, it is important to avoid using foreign bodies, remove talk from surgical gloves, and drapes used to be imbibed, so that peritoneal surface is constantly moisturized. The last few years, a plethora of materials has been developed, designed to separate traumatized peritoneal surfaces. Their effectiveness, though, has not been proven in large randomized trials.

Keywords: adhesion, post-operative, prevention

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