{"id":184,"date":"2025-10-09T15:08:32","date_gmt":"2025-10-09T05:08:32","guid":{"rendered":"https:\/\/escope.ages.com.au\/october-2025\/?p=184"},"modified":"2025-10-24T08:49:37","modified_gmt":"2025-10-23T22:49:37","slug":"journal-club-adhesion-barriers-in-gynaecological-surgery","status":"publish","type":"post","link":"https:\/\/escope.ages.com.au\/october-2025\/journal-club-adhesion-barriers-in-gynaecological-surgery\/","title":{"rendered":"Journal Club – Adhesion Barriers in Gynaecological Surgery"},"content":{"rendered":"\n

\n\t\t\tAdhesion Barriers in Gynaecological Surgery\t<\/h1>\n\t\t\t\t

Peritoneal adhesions occur in over half of patients after gynaecological surgery and may cause pain, infertility, bowel obstruction, and surgical complications. They develop from reduced fibrinolysis after tissue trauma, influenced by CO\u2082, intra-abdominal pressure, surgical technique, and patient factors. Adhesion barriers aim to reduce adhesions by physically separating tissues during healing.<\/p>\n

Aref-Adib et al.1<\/sup> and Schaefer et al.2<\/sup> recently published reviews on adhesion barriers in gynaecological surgery. Aref-Adib et al. focused on laparoscopic procedures, while Schaefer et al. conducted a systematic review of randomised controlled trials (RCTs) across all gynaecological surgeries, limiting inclusion to studies with re-look laparoscopy for adhesion assessment.<\/p>\n
\nFigure 1: The different types of adhesion barriers\n\t\t\t

Solid Barriers<\/h3>\t\t\t\n\t\t\t\t

Oxidised Regenerated Cellulose (ORC)<\/strong>
Interceed, made of oxidised regenerated cellulose, is an absorbable sheet applied directly to damaged peritoneum. Once placed, it transforms into a gel coating that is fully absorbed within two weeks. However, contact with blood may increase fibrin deposition and paradoxically worsen adhesions. Aref-Adib et al. cited two meta-analyses that found Interceed reduced both incidence and recurrence of adhesions. Schaefer et al. included 14 RCTs in their review; six demonstrated a significant reduction in adhesions, while the remainder did not.<\/p>\n

Hyaluronate-Carboxymethylcellulose<\/strong>
Seprafilm is composed of chemically modified sodium hyaluronate-carboxymethylcellulose. Within 24-48 hours it becomes a gelatinous barrier and is absorbed by seven days. The sheets are brittle, limiting their use in laparoscopy, although Aref-Adib et al. noted that they can be adapted by mixing with saline and instilling the suspension through a laparoscopic catheter. They included one RCT showing reduced incidence, extent, and severity of adhesions. Schaefer et al. added another trial, performed after caesarean section, which did not demonstrate improvement.<\/p>\n\t\t\t

Liquid and Gel Barriers<\/h3>\t\t\t\n\t\t\t\t

Hyaluronic Acid Gel<\/strong>
HyaRegen, a cross-linked hyaluronic acid gel, may prevent adhesions in laparoscopy and hysteroscopy by separating tissues and reducing inflammation during healing. Aref-Adib et al. cited two meta-analyses showing reduced adhesions. In Schaefer’s review, six of eight RCTs reported significant benefit.<\/p>\n

Polyethylene Glycol (PEG) Barriers<\/strong>
PEG-based sprays form a gelatinous coating lasting five to seven days. Aref-Adib et al. found mixed results: one meta-analysis showed reduced adhesions, while a systematic review found no effect. Schaefer et al. reported similarly inconsistent outcomes – Coseal was effective in one low-quality study, while Oxiplex\/AP Gel reduced adhesions in two of three RCTs.<\/p>\n

Icodextrin<\/strong>
Adept, a 4% icodextrin solution, prevents adhesions via hydroflotation. Aref-Adib et al. found mixed evidence, with one RCT showing marginal benefit but a meta-analysis showing none. Schaefer et al. included three RCTs; only one demonstrated improvement in adhesion scores.<\/p>\n\t\t\t

Powder Barriers <\/h3>\t\t\t\n\t\t\t\t

Modified Starch Powder<\/strong>
A modified starch powder that acts as both haemostatic agent and adhesion barrier, 4DryField is applied as a powder then covered in saline to form a gel. Shaefer et al included one RCT which showed an 85% improvement in adhesions.<\/p>\n\t\t\t

Conclusion<\/h3>\t\t\t\n\t\t\t\t

Overall, evidence supporting adhesion barriers in gynaecological surgery remains limited and inconsistent. While some products show promise, results vary across trials. These barriers may supplement meticulous surgical technique, but more robust, high-quality RCTs are required to support their use.<\/p>\n\t\t\t\t\"TABLE\n\t\t\t

References<\/h3>\t\t\t\n\t\t\t\t
    \n
  1. Aref\u2010Adib M, Phan T, Ades A. Preventing adhesions in laparoscopic surgery: the role of anti\u2010adhesion agents. Obstet Gynaecol<\/em>. 2019;21(3):185-192. doi:10.1111\/tog.12588<\/li>\n
  2. Schaefer SD, Alkatout I, Dornhoefer N, et al. Prevention of peritoneal adhesions after gynecological surgery: a systematic review. Arch Gynecol Obstet<\/em>. 2024;310(2):655-672. doi:10.1007\/s00404-024-07584-1<\/li>\n<\/ol>\n\t\t\t\t\"escope-2025-10__author-georgia-hunt-001\"\n\t\t\t\t

    Georgia Hunt
    BSci, MBBS
    <\/em>Level 5 RANZCOG Trainee
    Monash Women’s | Monash Health\u00a0<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"

    A review of the current evidence on adhesion barriers in gynaecological surgery, comparing types, mechanisms, and effectiveness in reducing postoperative adhesions.<\/p>\n","protected":false},"author":1,"featured_media":72,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-184","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorised"],"acf":[],"_links":{"self":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/comments?post=184"}],"version-history":[{"count":6,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/184\/revisions"}],"predecessor-version":[{"id":364,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/posts\/184\/revisions\/364"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media\/72"}],"wp:attachment":[{"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/media?parent=184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/categories?post=184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/escope.ages.com.au\/october-2025\/wp-json\/wp\/v2\/tags?post=184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}