Applying Different Innovative Ideas in Reduction of Post-operative Adhesion Formation: A Systematic Review and Meta-analysis

Development of adhesions is the most common consequence of intra-abdominal and pelvic surgery and a significant, yet poorly recognizable, reason of morbidity in post-operative patients.. Use of ‘good surgical technique’and use of PRP (plasma rich plasma) is recommmended as a prior step in prevention of adhesions. However, confirmation is needed for the evidence for different surgical techniques to reduce adhesion formation. This review add to the expanding pool of knowledge by illuminating factors that certainly influence the development of adhesions.

The PubMed database was used to conduct a search for all pertinent English-language articles in the literature, which were then evaluated with a focus on the risk factors for the development of post-operative adhesions. Each article's reference lists were also examined to find any additional pertinent works.

A new ray of hope for adhesion prevention in the form of plasma rich protein (PRP) is good option. Various factors have been shown to directly magnify the risk of post-operative adhesion development; namely, certain genetic polymorphisms in the interleukin-1 receptor antagonist, increased estrogen exposure, and endometriosis. In addition, many factors are known to augment the chance of fibrosis, thereby increasing the possibility of adhesion development concomitantly.

28 papers with 27 studies have been included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. The prevalence of adhesive small bowel obstruction was not significantly reduced by any of the techniques that were compared. The rate of pregnancy increased following subserous fixation of suture knots in a small, low-quality trial. However, compared to open surgery, laparoscopic surgery had a lower incidence of adhesions (relative risk (RR) 0.14; 95% confidence interval (CI): 0.03-0.61) and non-peritoneal closure (RR 0.36; 95% CI: 0.21-0.63).

The literature reviewed in this paper will help to explicit future research in apprehension of the mechanisms that focus on the interrelation of certain factors with development of adhesions. This information will be important in the designing appropriate preventative and treatment techniques.

None of the specific techniques that were compared were able to lower the two chief adhesion-related clinical consequences, small bowel obstruction and infertility. The meta-analysis contributes little evidence for the surgical principle that usage of fewer invasive techniques, introduction of fewer foreign bodies or causing slight ischaemia decrease the extent and severity of adhesions. Platelet-rich plasma has a diminishing effect on the postoperative peritoneal adhesions in rats.