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Minerva Ginecologica 2011 February;63(1):47-70


language: Italian

Prevention of postoperative abdominal adhesions in gynecological surgery. Consensus paper of an italian gynecologists’ task force on adhesions

Mais V. 1, Angioli R. 2, Coccia E. 3, Fagotti A. 4, Landi S. 5, Melis G. B. 1, Pellicano M. 6, Scambia G. 4, Zupi E. 7, Angioni S. 1, Arena S. 8, Corona R. 1, Fanfani F. 4, Nappi C. 6

1 Divisione di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione Umana, Dipartimento Chirurgico, Materno-Infantile e Scienze delle Immagini, Università di Cagliari, Ospedale San Giovanni di Dio, Cagliari, Italia 2 Dipartimento di Ostetricia e Ginecologia, Università Campus Biomedico di Roma Roma, Italia 3 Dipartimento Scienze Salute della Donna e del Bambino AOUC Careggi, Università di Firenze, Firenze, Italia 4 Divisione di Ginecologia Oncologica, Dipartimento di Ostetricia e Ginecologia, Università Cattolica del Sacro Cuore Roma, Italia 5 Unità Operativa di Ginecologia e Ostetricia, Ospedale di Desenzano del Garda, Desenzano del Garda, Brescia, Italia 6 Dipartimento di Ostetricia e Ginecologia, Università di Napoli Federico II, Napoli, Italia 7 Dipartimento di Ostetricia e Ginecologia, Università Tor Vergata, Roma, Italia 8 Dipartimento di Ostetricia e Ginecologia, Azienda Ospedaliera di Perugia, Perugia, Italia


Adhesions are the most frequent complication of abdominopelvic surgery, causing important short- and long-term problems, including infertility, chronic pelvic pain and a lifetime risk of small bowel obstruction. They also complicate future surgery with considerable morbidity and expense, and an important mortality risk. They pose serious quality of life issues for many patients with associated social and healthcare costs. Despite advances in surgical techniques, the healthcare burden of adhesion-related complications has not changed in recent years. Adhesiolysis remains the main treatment although adhesions reform in most patients. There is rising evidence, however, that surgeons can take important steps to reduce the impact of adhesions. A task force of Italian gynecologists with a specialist interest in adhesions having reviewed the current evidence on adhesions and considered the opportunities to reduce adhesions in Italy, have approved a collective consensus position. This consensus paper provides a comprehensive overview of adhesions and their consequences and practical proposals for actions that gynecological surgeons in Italy should take. As well as improvements in surgical technique, developments in adhesion-reduction strategies and new agents offer a realistic possibility of reducing adhesion formation and improving outcomes for patients. They should be adopted particularly in high risk surgery and in patients with adhesiogenic conditions. Patients also need to be better informed of the risks of adhesions.

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