Adhesion Prevention in Endometriosis: A Neglected Critical Challenge

被引:50
作者
Somigliana, Edgardo [1 ]
Vigano, Paola [3 ]
Benaglia, Laura
Busnelli, Andrea [2 ]
Vercellini, Paolo [2 ]
Fedele, Luigi [2 ]
机构
[1] Osped Maggiore Policlin, Fdn Ca Granda, Dept Obset Gynecol, I-20122 Milan, Italy
[2] Univ Milan, Milan, Italy
[3] Ist Sci San Raffaele, Obstet & Gynecol Unit, I-20132 Milan, Italy
关键词
Endometriosis; Adhesion; Prevention; OVARIAN ENDOMETRIOSIS; LAPAROSCOPIC SURGERY; RECTOVAGINAL SEPTUM; RANDOMIZED-TRIAL; CHOCOLATE CYSTS; INFERTILITY; RECURRENCE; DISEASE; PLEA; PAIN;
D O I
10.1016/j.jmig.2012.03.004
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Prevention of adhesions, whether de novo or by re-formation, is one of the most important and surprisingly neglected aspect of the treatment of endometriosis. Adhesions may cause infertility, dyspareunia, chronic pelvic pain but also intestinal obstruction and complications at subsequent surgery. They may play a role in the development of some forms of the disease such as ovarian endometriomas and possibly also deep invasive nodules. Three randomized controlled trials have been published documenting some partial success with Interceed, Oxiplex/AP gel or Adept solution in reducing adhesions extent at second look laparoscopy performed a few weeks after initial surgery. However, data on relevant long-term outcomes such as fertility, pelvic pain or disease recurrences or other adhesions-related complications is lacking. Noteworthy, endometriosis is a chronic inflammatory disorder and the insult causing adhesions is expected to persist after surgery. Therefore preventing adhesion formation with exclusively agents at the time of surgery may be insufficient. Future studies should focus on a 2-step strategy that includes measures applied at the time of surgery and subsequent administration of agents able to prevent the development of new adhesions. Journal of Minimally Invasive Gynecology (2012) 19, 415-421 (C) 2012 AAGL. All rights reserved.
引用
收藏
页码:415 / 421
页数:7
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