Adjuvant Therapy for the Reduction of Postoperative Intra-abdominal Adhesion Formation

BACKGROUND: To review currently available evidence on the use of adjuvant therapy to reduce the formation of postoperative intra-abdominal adhesions. METHODS: A search on Pubmed and the Cochrane library was undertaken using the keywords "abdominal", "adhesion", "postoperative", "prevention" and "reduction". Only randomised controlled trials, prospective non-randomised controlled studies and review articles published in the English language between 1990 and 2006 were included. RESULTS: Two prospective non-randomised controlled studies and 18 randomised controlled trials were included in this review. Adjuvant therapies reviewed included pharmacological agents (streptokinase, recombinant tissue plasminogen activator, vitamin E antioxidant molecules), and mechanical barriers (hyaluronic acid barriers, oxidised regenerated cellulose barriers, nanofibrous barriers and collagen foils). Hyaluronate/carboxymethylcellulose-based bioresorbable membrane (Seprafilm) appeared to be the most efficacious in reducing adhesion formation as well as decreasing the incidence of adhesion obstruction requiring reoperation in clinical studies. Drawbacks to the use of Seprafilm include high cost and complications such as haemorrhage and poor wound healing. CONCLUSIONS: Only a limited number of adjuvant treatment methods are currently available for the reduction of postoperative adhesions. Seprafilm has been proven to be the efficacious method to reduce adhesions. Investigations into the novel therapies are showing promising results in experimental studies and clinical studies before their wider application. [Asian J Surg 2009;32(3):180-6]