Types of adhesion prevention agents
What are the different types of adjuvants used to prevent adhesions?
Adhesion formation and reformation are still an unavoidable event in reproductive pelvic surgery in spite of the variable skills in microsurgery and endoscopic surgery.
This fact necessitates the search for barrier that can be used in the perioperative period.
There have various barriers or adjuvants that have been used but none have conclusively proven to be effective in various studies.
CLASSES OF ADHESION-REDUCTION ADJUVANTS AND THEIR PROPOSED MECHANISM OF ACTION
I. Fibrinolytic agents (fibrinolysis, stimulation of plasminogen activators)
Fibrinolysin
Streptokinase
Urokinase
Hyaluronidase
Chymotrypsin
Trypsin
Pepsin
Plasminogen activators
II. Anticoagulants (prevention of clot and fibrin formation)
Heparin
Citrates
Oxalates
III. Anti-inflammatory Agents (reduce vascular permeability, reduce histamine release and, stabilize lysozomes)
Corticosteroids
Nonsteroidal anti-inflammatory agents
Anti-histamines
Progesterone
Calcium channel blockers
Colchicine
VI. Antibiotics (prevent infection)
Tetracyclines
Cephalosporins
V. Mechanical Separation (surface separation, hydroflotation)
A. Intra-abdominal Instillates:
Dextran
Mineral oil
Silicone
Vaseline
Crystalloid solutions
Carboxymethylcellulose
Hyaluronic acid
Chelated hyaluronic acid
Poloxamer
B. Barriers:
Endogenous tissues:
Omental grafts
Peritoneal grafts
Bladder strips
Fetal membranes
Exogenous materials:
Fibrin glue
Polytetrafluoroethylene
Oxidized cellulose
Oxidized regenerated cellulose
Gelatin
Rubber sheets
Metal foils
Plastic hoods
Modified from Diamond MP, DeCherney AH: Pathogenesis of adhesion formation/reformation: Application to reproductive pelvic surgery. Microsurgery 1987: 8: 103 and Diamond MP, Hershlag A: Adhesion formation/reformation: in Treatment of postsurgical Adhesions, Wiley-Liss, Inc. 1990: 23-33.
