Adhäsionen: Fortschritte im Bereich der Adhäsionsprophylaxe und Therapie bei Laparotomie und Laparoskopie

Zusammenfassung

Adhäsionen entstehen bei allen chirurgischen Interventionen, wenn eine lokalisierte Hypoxie die Fibrinolyse unterdrückt und sich Fibrin auf die traumatisierte Oberfläche anlagert. Eine Prävention peritonealer Adhäsionen bei operativen Eingriffen ist sinnvoll. Dies zeigen die klinischen Konsequenzen von Adhäsionen, wie chronische Unterleibsbeschwerden, Sterilität und Infertilität, Darmverschluss und Infektionen. Die Erfassung der wirtschaftlichen Bedeutung von Adhäsionen und ihre Therapie, die Aufzählung der bekannten Prävention von Adhäsionen und letztlich die Analyse einer klinischen Studie eines neuen Adhäsionsprophylaktikums und Beschreibung einer geplanten randomisierten Studie weisen auf die Bedeutung der Prävention von peritonealen Adhäsionen hin. Die Applikation von Ringer-Lösung allein bringt weder bei Laparotomie noch bei Laparoskopie den gewünschten Erfolg. Daher kommt dem beschriebenen SprayGel® (Confluent Surgical Inc.) als Barrieresubstanz sowie der Applikation von Adept® als Spül- und Instillationsmittel am Ende der Operation eine große Bedeutung zu. Wahrscheinlich erbringt die Applikation einer Barrieresubstanz wie SprayGel® mit einer Spül- und Präventionsflüssigkeit für Adhäsionen wie Adept® in der Kombination einen echten Fortschritt in der Adhäsionsprophylaxe. Die randomisierte Studie von SprayGel® zeigte deutlich eine Reduktion neu entstandener Adhäsionen in der postoperativen Phase bei der Technik der Laparotomie und Laparoskopie bei Myomenukleationen. Kliniker sollten ein offenes Ohr für Fortschritte im Bereich der Adhäsionsprophylaxe haben.

Abstract

Adhesions are a frequent consequence of methothelial repair at sites traumatised by surgical procedures, such as laparoscopy or laparotomy, where localised hypoxia suppresses fibriolysis enabling fibrin to be deposited between adjacent tissue surfaces. Prevention of peritoneal adhesions at surgical procedures is essential as shown by the clinical consequences of adhesions: chronic abdominal pain, infertility, bowel occlusion and infections. The economic significance of adhesions and their therapy, as evaluated by known adhesion preventive measures, the analysis of a clinical study of a new adhesion prophylaxis and the description of a randomised study illustrate the importance of the prevention of peritoneal adhesions. The application of Ringers lactate does not bring the desired results. Therefore, the use of SprayGel® (Confluent Surgical Inc.) as a barrier substance and the application of Adept® as an instillation medium at the end of the operation are of significance.

Schlüsselwörter

Adhäsionsprophylaxe - gute chirurgische Technik - SprayGel® - Adept® - Laparotomie - Laparoskopie

Key words

Adhesion prophylaxis - good surgical technique - SprayGel® - Adept® - laparotomy - laparoscopy

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