Prevention of Adhesions in Gynecological Surgery: The 2016 Experts Recommendations on Adhesion Prophylaxis De Wilde RL 1* , Alvarez J 2 , Brölmann H 3 , Campo R 4 , Cheong Y 5 , Sardo ADS 6 , Koninckx P 7 , Lundorff P 8 , Pawelczyk L 9 , Roman H 10 , Torres-de-la-Roche LA 11 and Wallwiener M 12 1 Clinic of Gynecology, Obstetrics and Gynaecological Oncology, Medical Campus, University Hospital for Gynecology, Pius-Hospital Oldenburg, University of Oldenburg, Germany 2 Hospital Universitario Infanta Sofía, San Sebastián de Los Reyes, Spain 3 Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands 4 LIFE, Leuven Institute for Fertility and Embryology, Leuven, Belgium 5 Human Development and Health, Faculty of Medicine, University of Southampton and Complete Fertility Centre, Southampton, UK 6 First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece 7 University Hospital Gasthuisberg, Katholieke Universiteit, Leuven, Belgium 8 Department of Obstetrics and Gynecology, Privathospitalet Mølholm, Vejle, Denmark 9 Division of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, Poznan, Poland 10 Hopitaux De Rouen - Clinique Gynecologique et Obstetricale, Rouen Cedex, France 11 Department of Gynecology and Obstetrics, Carl von Ossietzky Universität, Oldenburg, Germany 12 Department of Obstetrics and Gynecology, University Clinic, Heidelberg, Germany * Corresponding author: Rudy Leon de Wilde, Clinic of Gynecology, Obstetrics and Gynaecological Oncology, Medical Campus, University Hospital for Gynecology, Pius-Hospital, University of Oldenburg, Georgstrasse 12, 26121 Oldenburg, Germany, Tel: 49-4412291501; E-mail: rudy-leon.dewilde@pius-hospital.de Received date: January 04, 2017; Accepted date: February 11, 2017; Published date: February 16, 2017 Copyright: © 2017 De Wilde RL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Post-operative adhesions are frequent sequela of abdominal and gynaecological surgery. They are associated with a high level of morbidity. This “field guideline” was written by a panel of European experts (anti-adhesions in gynecology expert group (ANGEL) and the European Society of Gynaecological Endoscopy (ESGE), adhesion research special interest group. It aims to provide surgeons with a quick reference guide to adhesion prevention adapted to the conditions of their daily practice. Keywords: Adhesions; Adhesiolysis; Adhesion prevention; Treatment guidelines; Anti-adhesion agents Adhesion Prevention It is well known that peritoneal adhesions, which could appear consequently to an infammatory process or afer surgical trauma, involve a broad spectrum of expensive, painful and difcult to treat sequela. Indistinctly of open or endoscopic surgery, the most frequent morbidities associated to adhesions are infertility, chronic abdominal pain, bowel obstruction, dyspareunia, and inadvertent enterotomy in subsequent abdominal procedures [1]. Afer operative hysteroscopy and sharp curettage, intrauterine adhesions also may cause ameno- or hypomenorrhea, cyclic pelvic pain, infertility, recurrent pregnancy loss and abnormal placentation [2]. Although the clinical consequences of intrauterine adhesions besides hypo- and amenorrhoea have not been elucidated yet, an association with infertility, miscarriage, premature delivery and abnormal placental invasion of the myometrium in subsequent pregnancies is suspected [2,3]. Additionally, the lysis of adhesions is followed by adhesion reformation [4] and no anti-adhesion agent had proved to prevent them at all. Terefore, symptoms related with adhesions or their complications increase the necessity of re-interventions, longer hospital stays, extend re-intervention times and limit the use of minimally-invasive techniques [5]. Consequently, the cost to patients and the health system increases: in the UK readmissions cost £24.2 and £95.2 million at 2 and 5 years afer surgery, respectively [6]. Despite this evidence, little has been invested in adhesion related research, prevention and or treatment. Moreover, many physicians are not aware of its impact on health-cost, litigation claims [7], and fnally on the quality of life of their patients. In order to enhance the awareness of adhesions, to promote scientifc research and to improve adhesion-related outcomes afer gynaecological surgeries, we have updated our ANGEL statement [5], providing physicians a quick reference guide to adhesion prevention, based on the best scientifc evidence and expertise. Tis up-dated “feld guideline” (Table 1), is adapted to clinical routine and could be used as a tool in the decision-making process during the pre-surgical counselling of patients, answering frequent patients concerns on the problematic of post-operative adhesions. Again, we encourage surgeons to adopt efective measures to prevent postoperative adhesions [5,8,20-23], by following fve basic rules of post-operative adhesion prevention suggested in our previous statement (Table 2), to which we added new recommendations when planning endometriosis surgery (Rule 3b) [23,24], or intrauterine procedures (Rules 3f, 4p and 4q) [23, 25]. In regards to routine second De Wilde, Gynecol Obstet (Sunnyvale) 2017, 7:2 DOI: 10.4172/2161-0932.1000428 Opinion Open Access Gynecol Obstet (Sunnyvale), an open access journal ISSN:2161-0932 Volume 7 • Issue 2 • 1000428 G y n e c o l o g y & O b s t e t r i c s ISSN: 2161-0932 Gynecology & Obstetrics