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Human Reproduction Update Advance Access originally published online on April 23, 2007
Human Reproduction Update 2007 13(4):379-394; doi:10.1093/humupd/dml061
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prevention of adhesions in gynaecological endoscopy

C. Nappi1, A. Di Spiezio Sardo1,2, E. Greco1, M. Guida1, S. Bettocchi3 and G. Bifulco1

1 Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘Federico II’, Via Pansini 5, Naples, Italy 3 Department of General and Specialistic Surgical Sciences, Section of Obstetrics and Gynaecology, University of Bari, Italy

2 To whom Correspondence should be addressed at: Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples ‘Federico II’, Via Pansini 5, Naples, Italy. Fax: +39-0817462905; E-mail: cdispie{at}tin.it

Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.

Key words: adhesion / endoscopy / prevention

Received on August 13, 2006; revised November 25, 2006; accepted on December 14, 2006


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