http://www.ethiconinc.com/womens_health/product/adhesions/prev_fr.htm
Surgical Techniques to Minimize Adhesion Formation
1. Achieve meticulous hemostasis
2. Maintain vascularity
3. Moisten tissues
4. Avoid dry sponges
5. Minimize tissue handling
6. Use fine, nonreactive sutures
7. Avoid peritoneal grafts
8. Minimize foreign bodies
Even though the most meticulous surgical and microsurgical techniques cannot eliminate the formation of adhesions, the following steps can be taken to reduce adhesion formation: 1. Achieve meticulous hemostasis: Inadequate hemostasis and the resultant fibrin deposition promote adhesion formation.
2. Maintain vascularity: Limiting ischemia supports fibrinolysis.
3. Moisten tissues: Frequent irrigation and the use of moist sponges prevent desiccation of tissue. Ringer's lactate or other irrigating solutions also eliminate any residual talc, lint, or blood clots, which may provide a nidus for a foreign body reaction, inflammation, and adhesion formation.
4. Avoid dry sponges: Use of gauze and dry sponges should be avoided because they may damage the peritoneal surface and leave a foreign body behind.
5. Minimize tissue handling: Manipulating tissue increases the possibility of vascular and tissue damage. When direct manipulation of the peritoneum is necessary, use either atraumatic instruments or fingers. In addition, cutting and coagulating should be kept to a minimum to reduce the possibility of trauma and maintain vascularity.
6. Use fine, nonreactive sutures: To minimize foreign body reactions use the smallest size of suture composed of synthetic material.
7. Avoid peritoneal grafts: Grafting increases the risk of peritoneal trauma while decreasing vascularity.
8. Minimize foreign bodies: Foreign bodies may damage the peritoneal surface, lead to inflammation, and ultimately result in adhesion formation.
The Ideal Barrier
1. Safe and effective
2. Absorbable
3. Permits peritoneal healing
4. Noninflammatory
5. Easy to use
6. No suturing necessary
7. Compatible with laparoscopy
Studies with existing barriers led investigators to identify the specific criteria for development of a barrier to adhesion formation. The ideal barrier should possess the following characteristics:
1. It should be safe and should provide a measurable reduction in the formation of adhesions.
2. The barrier needs to be absorbed within a short period of time.
3. It should allow peritoneal healing.
4. The barrier should not induce an inflammatory or foreign body response; in other words, it should be tissue compatible.
5. It must be easy to handle in a surgical setting.
6. The barrier must adhere to tissue surfaces without the need for sutures or other fixation mechanisms that might induce a foreign body response or promote ischemia.
7. And finally, the ideal barrier should be easy to use during laparoscopic procedures.