Adhesion prevention after endometriosis surgery — results of a randomized, controlled clinical trial with second-look laparoscopy

• Published in: Langenbeck's archives of surgery 2021-09, Vol.406 (6), p.2133-2143
• Main Authors: Krämer, Bernhard, Andress, Jürgen, Neis, Felix, Hoffmann, Sascha, Brucker, Sara, Kommoss, Stefan, Höller, Alice
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; Controlled Clinical Trials; Endometriosis - surgery; Female; General Surgery; Humans; Laparoscopy; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prospective Studies; Thoracic Surgery; Tissue Adhesions - etiology; Tissue Adhesions - prevention & control; Tissue Adhesions - surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-021-02193-x

Purpose Adhesion formation after endometriosis surgery is a severe problem affecting up to 90% of patients. Possible complications include chronic pain, ileus, and secondary infertility. Therefore, effective adhesion prophylaxis is desirable, for which the adhesion barrier 4DryField ® PH is evaluated in the present clinical study. It is a starch-based powder that forms a gel after irrigation with saline solution and thus separates surgical sites as physical barrier for adhesion prevention. Methods Fifty patients with extensive and deep infiltrating endometriosis were included in this prospective, randomized, controlled clinical trial with two-staged laparoscopic approach. The patients were randomized into two groups, one receiving 4DryField ® PH and the other irrigation with saline solution for adhesion prevention. Adhesion formation was directly scored during second-look interventions considering incidence, extent, and severity. Adhesion prevention treatment in the second surgery was performed corresponding to the first intervention to evaluate the long-term outcome in the later course. Results Both groups were comparable with respect to relevant patient parameters. Severity and extent of adhesions were significantly reduced by 85% in the 4DryField ® PH group compared to the control group (mean total adhesion score 2.2 vs. 14.2; p = 0.004). Incidence of adhesion formation based on the number of affected sites was significantly reduced by 53% in the intervention vs. control group (mean 1.1 vs. 2.3 sites; p = 0.004). Follow-up of secondary endpoints is not yet completed; results will become available at a later stage. Conclusion Adhesion formation could be reduced significantly by 85% by application of the adhesion barrier 4DryField ® PH. Trial registration Trial registration main ID: DRKS00014720, secondary ID: U1111-1213-4142; date of registration 09th May 2018.