Meta-analysis on the efficiency of adhesion barriers in gynecological abdominal surgery

Introduction: Adhesions are a common and frequent problem in every day work of obstetricians and visceral surgeons.

However, in spite of almost 50 years of research we do not have clear recommendations to the clinician which method for adhesion prevention to prefer.

Methods: We reviewed the entire scientific literature of the past 50 years related to the issue of adhesions (N = 21,899). With second-look surgery as a control of efficiency, 40 Studies remained for analysis. In order to gain a methodological comparability of the reviewed studies, subgroups were formed based on the most common Adhesion Scores (e.g. AFS), individual Adhesions scores (dichotomous analysis) and study-immanent qualitative criteria.

Results: A qualitative approach resulted in a significant improvement in a majority of patients. When applying metric criteria to measure the extent of adhesions, an improvement of 1/3 to 1/2 could be stated. A comparable trend could be seen when assessing the studies in a quantitative way.

An analysis based on the mechanism of action of the assessed substances resulted in a significant effect (approximately 1/3 improvement for the incidence and 1/3 improvement for the extent of adhesions) for gels and solid substances in a majority of the included studies (28 of 33). Empirical evidence for Fluids and systemic acting substances is inconsistent.

Conclusion: As a result it can be gathered that only barrier substances (hyaluronic acid, carboxymethylcellulose, polyethyleneglycole and synthetic PEG) should be considered for adhesion prevention. In most cases, this has to be a repeated treatment.