Text based upon : see our publications
Koninckx PR, Gomel V. Introduction: Quality of pelvic surgery and postoperative adhesions. Fertil Steril. 2016;106:991-993

Koninckx PR, Gomel V, Ussia A, Adamyan L. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril. 2016;106:998-1010.

Gomel V, Koninckx PR. Microsurgical principles and postoperative adhesions: lessons from the past. Fertil Steril. 2016;106:1025-1031.

Koninckx PR, Ussia A, Wattiez A, De Wilde RL. Laparoscopic management and prevention of pelvic adhesions and postoperative pain. In: Einarsson JI, Wattiez A, editors. Minimally invasive gynecologic surgery : Evidence based laparoscopic, hysteroscopic and Robotic surgeries. JP Medical limited, victoriastreet 83, London; 2016
Koninckx et al 2010 NEW CONCEPTS IN ADHESION PREVENTION : book chapter

Adhesions are a major clinical problem

Prevention is needed 

since no cure for existing adhesions

Mechanism of adhesion formation

The old model of postoperative adhesions  considers adhesion 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 of postoperative adhesions developed by our group has demonstrated that the acute inflammatory reaction in 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 of postoperative adhesions. 

Healing occurs within 3 days or adhesion formation starts

Classic Adhesion prevention

Classic

• good surgical practice = microchirurgical principles
  • fast
  • no blood loss
  • gentle tissue handling
  • prevent desiccation
  • no unnecessary dissection
• Barriers : 40-50 efficacy

Conditioning even more important

• peritoneal conditioning
• after surgery
  • cexamethasone
  • a barrier

Conditioning : our experiments in the mouse model

We discovered the good and the bad factors 

The good and the bad factors

A  Randomised clinical trial in the human

And less CO2 resorption

2001 Jerome Hoffman price of the aagl

1st Prize
BELGIAN SOCIETY OF
REPRODUCTIVE MEDICINE
2001 Molinas et al

1st Prize ESGE R. Palmer Prize.
2001 Molinas et al

1st Prize ESHRE
PROMISING YOUNG SCIENTIST AWARD
2002 ESHRE Molinas et al

1st Prize ESGE
Cagliari
2004 Binda et al