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Frauenheilkunde up2date 2012; 6(4): 221-236
DOI: 10.1055/s-0032-1314994
Allgemeine Gynäkologie und gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Operative Strategien bei Adhäsionen

A. Hirschelmann
,
R. L. De Wilde
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Publication Date:
30 August 2012 (online)

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Kernaussagen

Adhäsionen können heutzutage als die häufigste Komplikation abdominopelviner Eingriffe angesehen werden und haben weitreichende Konsequenzen für die betroffenen Patientinnen, die behandelnden Ärzte und das Gesundheitssystem. Die Behandlung von Patientinnen mit bestehenden Adhäsionen stellt sowohl während einer Operation als auch in der Nachbetreuung eine herausfordernde Aufgabe dar. Eine ausgedehnte Adhäsiolyse ist eine anspruchsvolle Operation und sollte aufgrund der damit verbundenen möglichen Komplikationen nur von operativ erfahrenen Ärzten durchgeführt werden. Hierbei ist ein bedachtes Vorgehen notwendig, um das Risiko für Gefäß-, Ureter- oder Darmverletzungen zu minimieren. Da Adhäsionen in einem Großteil der Patienten nach einer Adhäsiolyse wieder auftreten können, ist es sinnvoll, sich während jeder Operation Strategien anzueignen, um das Risiko der Adhäsionsentstehung zu minimieren und somit der Bildung von Adhäsionen von Beginn an vorzubeugen. Zwar können die derzeitig erhältlichen Adhäsionsbarrieren das Auftreten von Adhäsionen nicht komplett verhindern, jedoch kann durch ihren Einsatz die Entstehung von Adhäsionen reduziert werden.

 

  • Literatur

  • 1 Dubuisson J, Botchorishvili R, Perrette S et al. Incidence of intraabdominal adhesions in a continuous series of 1000 laparoscopic procedures. Am J ObstetGynecol 2010; 203: 111.e1
    Google Scholar
  • 2 Tinelli A, Malvasi A, Guido M et al. Adhesion formation after intracapsular myomectomy with or without adhesion barrier. Fertil Steril 2011; 95: 1780-1785
    CrossrefGoogle Scholar
  • 3 Trew G, Pistofidis G, Pados G et al. Gynaecological endoscopic evaluation of 4 % icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011; 26: 2015-2027
    CrossrefGoogle Scholar
  • 4 Brill AI, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol 1995; 85: 269-272
    CrossrefGoogle Scholar
  • 5 Menzies D, Ellis H. Intestinal obstruction from adhesions – how big is the problem?. Ann R Coll Surg Eng 1990; 72: 60-63
    Google Scholar
  • 6 Scott-Coombes D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolytic response to elective surgery. B J Surg 1995; 82: 414-417
    CrossrefGoogle Scholar
  • 7 Cheong YC, Laird SM, Li TC et al. Peritoneal healing and adhesion formation/reformation. Hum Reprod Update 2001; 7: 556-566
    CrossrefGoogle Scholar
  • 8 Mutsaers SE. Mesothelial cells: their structure, function and role in serosal repair. Respirology 2002; 7: 171-191
    CrossrefGoogle Scholar
  • 9 Hellebrekers BW, Kooistra T. Pathogenesis of postoperative adhesion formation. Br J Surg 2011; 98: 1503-1516
    CrossrefGoogle Scholar
  • 10 diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 2001; 7: 547-555
    CrossrefGoogle Scholar
  • 11 Herrick SE, Mutsaers SE, Ozua P et al. Human peritoneal adhesions are highly cellular, innervated, and vascularized. J Pathol 2000; 192: 67-72
    CrossrefGoogle Scholar
  • 12 Wallwiener M, Wallwiener CW. The pathogenesis of adhesion formation. In: De Wilde RL, Schmidt EH, Hrsg. State-of-the-art prevention of adhesions in gynecology. 1.. Aufl. Bremen: UNI-MED Verlag AG; 2010: 11-17
    Google Scholar
  • 13 Tietze L, Elbrecht A, Schauerte C et al. Modulation of pro- and antifibrinolytic properties of human peritoneal mesothelial cells by transforming growth factor beta1 (TGF-beta1), tumor necrosis factor alpha (TNF-alpha) and interleukin 1beta (IL-1beta). Thromb Haemost 1998; 79: 362-370
    Google Scholar
  • 14 Cheong YC, Laird SM, Shelton JB et al. The correlation of adhesions and peritoneal fluid cytokine concentrations: a pilot study. Hum Reprod 2002; 17: 1039-1045
    CrossrefGoogle Scholar
  • 15 Saed GM, Diamond MP. Modulation of the expression of tissue plasminogen activator and its inhibitor by hypoxia in peritoneal and adhesion fibroblasts. Fertil Steril 2003; 79: 164-168
    CrossrefGoogle Scholar
  • 16 Saed GM, Diamond MP. Hypoxia-induced irreversible up-regulation of type I collagen and transforming growth factor-β1 in human peritoneal fibroblasts. Fertil Steril 2002; 78: 144-147
    CrossrefGoogle Scholar
  • 17 White JC, Jiang ZL, Diamond MP, Saed GM. Macrophages induce the adhesion phenotype in normal peritoneal fibroblasts. Fertil Steril 2011; 96: 758-763.e3
    CrossrefGoogle Scholar
  • 18 DeWilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Gynecol Surg 2007; 4: 161-168
    CrossrefGoogle Scholar
  • 19 OʼConnor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc 2012; 26: 12-17
    CrossrefGoogle Scholar
  • 20 Hammoud A, Gago LA, Diamond MP. Adhesions in patients with chronic pelvic pain: a role for adhesiolysis?. Fertil Steril 2004; 82: 1483-1491
    CrossrefGoogle Scholar
  • 21 Vrijland WW, Jeekel J, Geldorp HJ et al. Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 2003; 17: 1017-1022
    CrossrefGoogle Scholar
  • 22 Swank DJ, Swank-Bordewijk SC, Hop WC et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. Lancet 2003; 361: 1247-1251
    CrossrefGoogle Scholar
  • 23 Caspi E, Halperin Y, Bukovsky I. The importance of periadnexal adhesions in tubal reconstructive surgery for infertility. Fertil Steril 1979; 31: 296-300
    Google Scholar
  • 24 Milingos S, Kallipolitis G, Loutradis D et al. Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci 2000; 900: 272-285
    CrossrefGoogle Scholar
  • 25 Sawada T, Nishizawa H, Nishio E, Kadowaki M. Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women. J Reprod Med 2000; 45: 387-389
    Google Scholar
  • 26 Pellicano M, Guida M, Bramante S et al. Reproductive outcome after autocrosslinked hyaluronic acid gel application in infertile patients who underwent laparoscopic myomectomy. Fertil Steril 2005; 83: 498-500
    CrossrefGoogle Scholar
  • 27 De Bruyne F, Hucke J, Willers R. The prognostic value of salpingoscopy. Hum Reprod 1997; 12: 266-271
    CrossrefGoogle Scholar
  • 28 Marana R, Catalano GF, Muzii L et al. The prognostic role of salpingoscopy in laparoscopic tubal surgery. Hum Reprod 1999; 14: 2991-2995
    CrossrefGoogle Scholar
  • 29 Nagata Y, Honjou K, Sonoda M et al. Peri-ovarian adhesions interfere with the diffusion of gonadotrophin into the follicular fluid. Hum Reprod 1998; 13: 2072-2076
    CrossrefGoogle Scholar
  • 30 van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M et al. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 2000; 87: 467-471
    CrossrefGoogle Scholar
  • 31 Brummer TH, Jalkanen J, Fraser J et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod 2011; 26: 1741-1751
    CrossrefGoogle Scholar
  • 32 Kumakiri J, Kikuchi I, Kitade M et al. Incidence of complications during gynecologic laparoscopic surgery in patients after previous laparotomy. J Minim Invas Gyn 2010; 17: 480-486
    Google Scholar
  • 33 Wilson MS. Practicalities and costs of adhesions. Colorectal Dis 2007; 9 (Suppl.) 60-65
    CrossrefGoogle Scholar
  • 34 De Wilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2 – steps to reduce adhesions. Gynecol Surg 2007; 4: 243-253
    CrossrefGoogle Scholar
  • 35 Molinas CR, Mynbaev O, Pauwels A et al. Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model. Fertil Steril 2001; 76: 560-567
    CrossrefGoogle Scholar
  • 36 Binda MM, Molinas CR, Hansen P, Koninckx PR. Effect of desiccation and temperature during laparoscopy on adhesion formation in mice. Fertil Steril 2006; 86: 166-175
    CrossrefGoogle Scholar
  • 37 Hirschelmann A, Tchartchian G, Wallwiener M et al. A review of the problematic adhesion prophylaxis in gynaecological surgery. Arch Gynecol Obstet 2012; 285: 1089-1097
    CrossrefGoogle Scholar
  • 38 Brown CB, Luciano AA, Martin D et al. Adept (icodextrin 4 % solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril 2007; 88: 1413-1426
    CrossrefPubMedGoogle Scholar
  • 39 Metwally ME, Lilford R, Vanderkerchove P. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 2006; (2) CD001298
    Google Scholar
  • 40 Ahmad G, Duffy JM, Farquhar C et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 2008; (2) CD000475
    Google Scholar
  • 41 Audebert AJ, Gomel V. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Fertil Steril 2000; 73: 631-635
    CrossrefGoogle Scholar
  • 42 Sepilian V, Ku L, Wong H et al. Prevalence of infraumbilical adhesions in women with previous laparoscopy. J Soc Laparoendoscop Surg 2007; 11: 41-44
    Google Scholar
  • 43 Schmidt EH, De Wilde RL. Standardverfahren der minimal-invasiven Chirurgie in der Frauenheilkunde. Operationsatlas der Laparoskopie. Suttgart: Thieme Verlag; 1998
    Google Scholar
  • 44 diZerega GS, Verco SJ, Young P et al. A randomized, controlled pilot study of the safety and efficacy of 4 % icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery. Hum Reprod 2002; 17: 1031-1038
    CrossrefGoogle Scholar
  • 45 Swank DJ, Hop WC, Jeekel J. Reduction, regrowth, and de novo formation of abdominal adhesions after laparoscopic adhesiolysis: a prospective analysis. Dig Surg 2004; 21: 66-71
    CrossrefGoogle Scholar
  • 46 Luciano DE, Roy G, Luciano AA. Adhesion reformation after laparoscopic adhesiolysis: where, what type, and in whom they are most likely to recur. J Minim Invas Gyn 2008; 15: 44-48
    Google Scholar