Prevention of postoperative adhesions

Koninckx et al 2010 NEW CONCEPTS IN ADHESION PREVENTION : Click for the complete text of this review

Last International Presentations

Postoperative Adhesions are a major clinical problem

Postoperative adhesions occur in 80% after surgery and cause chronic pain, infertility and bowel obstruction. Thus 30% van alle chronic pain in women, 30% of infertilities 100% of all bowel obstructions are caused by postoperative adhesions

Right : the peritoneal cavity
Middle : tthe clinical consequences

Pathophysiology

The old model (above and to the right) considers beschouwt adhaesion formation as a cascade of local processes between denuded areas. Either repair is rapid within a few days or adhesion formation starts
The new model developed by our group has demonstrated that the peritoneal cavity is 20 times more important than this local process . The sum of all the good and bad factors will determine the degree of acute inflammation of the peritoneal cavity and thus of adhesions. In summery these are :
Duration of surgery and the degree of manipulation (For this reason a slow or less experienced surgeon will have more adhesions )
Desiccation will occur systematically unless specific preventive measurements are taken such as the patented cooling with a third means.
A better gas mixture instead of CO2 that is very irritant
de Recently that lower temperatures induce less adhesions was confirmed see letter to the editor and the answer
2010Binda_letter.pdf
If all factors are controlled by conditioning adhaesion formation is reduced by over 70%.

This work received a series of international prices

prevention of adhesions :
first conditioning
then a barrier

prevention of adhesions today : with the old model: Maximum 40-50% effective

prevention of adhesions based upon the old model is done by using “barriers” of “Flotation agents” in order to keep the surgical surfaces separated for a few days. All available products have an effectivity of 40 tot 50% at best and this for specific (simple) interventions performed by esperts. In addition, the variability of results is high.
Therefore effectivity has not been demonstrated for any product for a clinical endpoint as infertility, or pain or reintervention. These products are marketed as devices. Only for Adept safety has been extgensively demonstrated . This is the only product approved by the FDA today.

The future of prevention of adhesions : first conditioning of the peritoneal cavity

We do expect that in the very near future we will be able to perform surgery without adhesions by peritoneal conditioning. This was described first ascombination therapy.

Developed clinically in cooperation with eSaturnus NV

Clinical trials

Other advantages of Conditioning of the peritoneal cavity

less postoperative pain , estimated at a 60% decrease.
Less CO2 resorbtion is a major advantage for laparoscopic surgery of longer duration especially in more obese patients
Less tumor metastasis, if confirmed in the human, the importance is obvious in reducing mortality

Important articles of the goup

2009 Schonman et al : surgical manipulation
2006 Binda :cooling
2004 Elkilani : ringers lactate for adhesion prevention
2003 Binda : ROS and adhesions
2001 Molinas : effect of hypoxia

Images of adhesions