Adhäsionen und ihre Prävention in der gynäkologischen Chirurgie: Standortbestimmung und aktueller Konsensus basierend auf den Ergebnissen von vier Workshops

Zusammenfassung

Das Problem postoperativer Adhäsionen hat neue Aktualität erlangt durch die kürzliche Publikation bis dahin nicht verfügbarer epidemiologischer Daten zu adhäsionsbedingten Spätfolgen und Komplikationen. Gleichzeitig scheinen neue Verfahren erstmals eine realistische Chance zur Reduktion des Adhäsionsrisikos zu bieten.

Da evidenzbasierte Empfehlungen noch ausstehen, wurde in einem ersten Schritt eine orientierende Standortbestimmung erarbeitet, die als Konsensus auf den Ergebnissen von vier durch die Autoren geleiteten Roundtable-Workshops unter Beteiligung von Kolleginnen und Kollegen aus 35 deutschen Kliniken basiert.

Zur Bedeutung von Adhäsionen bleibt festzuhalten, dass ein großes Spektrum gynäkologischer Operationen, und zwar in offener, aber auch endoskopischer Technik, Adhäsionen in relevantem Maße induzieren. Dies begründet die Forderung nach einer effizienten Adhäsionsprävention, die derzeit am ehesten durch die Applikation so genannter Barriereprodukte erfüllt wird. Zur Verfügung stehen einerseits lokal wirksame viskose Substanzen. Für die neueren Polyethylenglycol- und Hyaluronsäureprodukte stehen Daten noch weitgehend aus, während die Wirksamkeit regenerierter oxidierter Zellulose gut untersucht ist. Von möglichem Vorteil durch seine Verteilung und Wirkung im gesamten Peritonealraum erscheint andererseits Icodextrin, das im Gegensatz zu mehreren bereits wieder vom Markt genommenen Produkten als sicher in der Anwendung gelten und vielversprechende erste Studiendaten zur antiadhäsiven Wirksamkeit aufweisen kann.

Abstract

The problem of postoperative adhesions has gained a new topicality by the recent publication of epidemiological data on adhesion associated consequences and complications, not available so far. At the same time, new methods seem to offer a realistic chance of adhesion risk reduction.

As evidence-based recommendations are lacking so far, a definition for a more general orientation in the form of a consensus is presented as a first step, based on the results of four roundtable workshops held by the authors and with the contributions from collegues of 35 German hospitals.

With respect to the importance of adhesions it can be stated that a large spectrum of gynaecologic operations, open as well as laparoscopic, induce adhesions to a relevant extent. This is the reason behind the request for efficient adhesion prevention, which is currently met best by the application of so-called barrier products. On the one hand, viscous substances with local effect are available. For the newer polyethylenglycol and hyaluronic acid products data are still lacking, but the efficacy of regenerated oxydized cellulose is well investigated. On the other hand, a possible advantage with an effect throughout the entire peritoneal cavity seems to exist for icodextrin. The substance has proven to be safe in contrast to several other products already withdrawn from the market and shows promising first study data with respect to its anti-adhesive efficacy.

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