Chapter 67: Fundamental Anti-Adhesion Surgical Techniques

Hilgers TW

Reproductive Surgery · Adhesion Prevention

Chapter 67: Fundamental Anti-Adhesion Surgical Techniques

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 907-932, 2004

RRM Academy Synopsis

Pelvic surgery adhesion prevention takes many techniques combined

A 2004 surgery textbook chapter, one surgeon's expert opinion, says reducing pelvic adhesions takes many steps used together. It lists the steps in order. Cited trials and photos of single cases back it.

Key Findings

The chapter states that pelvic surgical injury may start a cascade that produces a fibrin exudate, which may develop into adhesions in as little as three hours.
The chapter lists its techniques in the general order used in the operating room: skin incision, irrigation, suture choice, tissue closure, barriers, then closing the peritoneum.
The chapter reports that an absorbable cellulose barrier works four times better than controls at stopping adhesions from re-forming, in a matched sidewall comparison.
Photographed cases show adhesions gone at second-look laparoscopy 10 days after surgery with a removable membrane in place, including a patient whose tubes were open.
Most studies found a dextran instillate helpful and a few suggested it is not. The author uses it at every procedure and calls it a useful adjunct.

RRM Context

The chapter names adhesion prevention as a main principle of surgical NaProTECHNOLOGY. The stated goal is surgery that avoids adhesions and preserves procreative function. Excision of disease leaves raw tissue behind. Closure and barrier choices belong to the same plan as the excision.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes the anti-adhesion techniques used in surgical NaProTECHNOLOGY and states that no single approach or technique produces an adhesion-free result on its own. The techniques run from a hemostatic skin incision and hydro-packs in place of laparotomy packs through intermittent irrigation, suture choice, inverting closure of surface tissue, optional uterine suspension, anti-adhesion barriers, clear irrigation fluid, intraperitoneal instillates and closure of the parietal peritoneum. Hilgers reports over 20 years of experience with polypropylene (Prolene) suture for closing surface tissues and a nearly universal absence of adhesions at the suture sites on follow-up laparoscopy. The chapter also reviews intraperitoneal instillates such as dextran 70 (Hyskon) and the barriers Interceed TC-7, Gore-Tex surgical membrane and Seprafilm, with case photographs taken at second-look laparoscopy.

Topics

Reproductive Surgery Adhesion Prevention Surgical Technique and Adhesions

Reproductive Surgery › Adhesion Prevention › Surgical Technique and Adhesions

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 67: Fundamental Anti-Adhesion Surgical Techniques

Pelvic surgery adhesion prevention takes many techniques combined

Key Findings

RRM Context

Abstract

Topics

By this author

Related research