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.
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All surgical procedures will cause adhesions to form!! The formation of adhesions is a completely natural process, which occurs as the human body attempts to heal and protect itself following a surgical procedure. Unless a surgeon adheres to the above adhesion-prevention techniques, their surgical patient will be "set up" to form adhesions.
The above adhesion-prevention techniques are being used by *some* surgeons to prevent the return of adhesions after a surgical procedure. The critical time element when adhesions will form is - in as few as 3 hours and up to 7 days. That is why a second look laparoscopy is so important after an adhesiolysis. Unfortunately, in the United States and many countries around the world, a second look laparoscopy is not offered as a routine adhesion-prevention technique following an adhesiolysis procedure.
Based on my experience, I know that both Dr. Matthias Korell (Duisburg, Germany) and Dr. Daniel Kruschinski (Frankfurt, Germany) offer and do perform second look procedures - if they feel a second look is warranted.
If any adhesions have re-formed within the critical time period of 7 days, a second look provides these dedicated surgeons with the opportunity to lyse any adhesions that may have re-formed - as well as any new (de novo) adhesions that may have formed.
Within a 7-day time period, adhesions are filmly (like cobwebs) and are easily "swept down" by the surgeon. At the conclusion of the second look these surgeons apply additional SprayGel Adhesion Barrier to the areas that are in need of additional adhesion-prevention.
Even though SprayGel has not yet been approved by the FDA in the United States, SprayGel has been approved and is being used by surgeons in Australia, throughout Europe and in the United Kingdom.
[Note: You may want to print-out and share this very important information with your doctor/surgeon. At the very least, you will want to discuss these adhesion-prevention techniques prior to agreeing to a surgical procedure of any kind. Adhesions are the number one complication/risk of surgery!!]