Its usefulness is limited because of the need to be removed surgically at a later stage. Various Bioabsorbable gels have been developed and tested, but most have been abandoned or withdrawn because of safety issues or a lack of efficacy. SprayGel is a sprayable hydrogel that adheres to the tissues for a period of 5 to 7 days. After several days it is hydrolyzed into water-soluble molecules and is absorbed. Safety of SprayGel has been shown in a few gynecologic and colorectal studies, however although early preliminary clinical trials showed its
effectiveness, a larger-scale study was stopped owing to a lack of efficacy [172]. Finally a systematic review of barrier agents for adhesion prevention after gynaecological surgery assessed the effect of physical barriers used buy PR-171 during pelvic surgery in women SB431542 ic50 of reproductive age on pregnancy rates, pelvic pain, or postoperative adhesion reformation [173]. The authors’ conclusions were that the absorbable adhesion barrier Interceed reduces the incidence of adhesion formation following
laparoscopy and laparotomy. Gore-Tex may be superior to Interceed in preventing adhesion formation but its usefulness is limited by the need for suturing and later removal. There was no evidence of effectiveness of Seprafilm and Fibrin sheet in preventing adhesion formation. Chemical/Fluid agents Fluid agents have the theoretical advantage of covering more potential sites of adhesion formation than mechanical barriers. A systematic review updated at 2006 [174], regarding fluids Cediranib (AZD2171) and pharmacological agents for adhesion prevention after gynaecological surgery, found insufficient evidence for the use of the following
agents: steroids, icodextrin 4%, SprayGel and dextran in improving adhesions following surgery. There was some evidence that hyaluronic acid agents may decrease the proportion of adhesions and prevent the deterioration of pre existing adhesions but the need of further studies was advocated. The most widely studied and the only Food and Drug Administration-approved adhesion-prevention fluid agent in laparoscopic surgery is Adept (Baxter Healthcare, Deerfield, IL). Adept (icodextrin 4% solution) is used as an irrigant fluid throughout surgery and at the end of surgery 1,000 mL is instilled and left in the peritoneal cavity. The fluid remains in the peritoneal cavity for several days and separates the damaged surfaces during the critical period of adhesion formation. A large multicenter, prospective, randomized, double-blind study by Brown et al [175] compared Adept (N = 203) with lactated Ringer’s solution (N = 199), in women undergoing laparoscopic gynecologic surgery for adhesiolysis. The study patients returned for a second laparoscopy within 4 to 8 weeks. Adept was significantly more likely to reduce adhesions and improve fertility scores than lactated Ringer’s solution.