| Problem: Adhesions are fibrous, occasionally vascular bands of scar tissue that connect normally separated organs or tissues and are an almost inevitable result of peritoneal surgery commonly occurring after abdominal, gynecological, dental, thoracic and cardiac procedures. An estimated 90% of patients undergoing major abdominal surgery and 55% to 100% of women undergoing pelvic surgery develop adhesions. Postoperative morbidities including intestinal obstruction, chronic pelvic or abdominal pain, dysparunia, secondary infertility and subsequent complications during repeat operations often require re-admission to the hospital and additional surgery. There are multiple techniques and adjuvants a surgeon can use to prevent adhesion formation including using proper surgical techniques, pharmacological anti-adhesive agents and barriers, like Seprafilm. Methods: Searches were performed through the Weill Cornell Medical Library online in the PubMed database using the search terms: "Seprafilm" AND "adhesions", "adhesion prevention", "gynecological surgery AND "adhesion prevention", "prevention" AND "pelvic adhesions", "peritoneal adhesions", "intra-abdominal adhesions" AND "prevention", "barriers" AND "adhesion prevention." Results: A total of 14 articles were used for this literature review. The search identified three unique studies pertaining to gynecological surgery, one Cochrane review and one meta-analysis. These articles were analyzed for the literature review and the remaining six articles, along with three literature reviews found, were used for background information only. Conclusions: Further research on the use of adhesion reducing barriers, such as Seprafilm, after cesarean deliveries, will benefit patients by decreasing morbidities associated with adhesive disease and would present an opportunity for significant cost savings in healthcare expenditure. |
