With continuous advancements in medical technology, laparoscopic surgery and robotic-assisted surgery have become mainstream approaches in modern surgical practice.
Although minimally invasive surgery is widely recognized for its smaller incisions and faster recovery, many patients mistakenly assume that smaller wounds eliminate the risk of postoperative adhesions. In reality, clinical studies indicate that approximately 93% [i] of patients may develop postoperative adhesions following abdominal surgery, regardless of surgical technique. Severe adhesions may lead to chronic pain, bowel obstruction, or infertility.
Postoperative adhesions are difficult to predict—not only whether they will occur, but also when they may develop. Therefore, prevention remains more effective than treatment. Particularly in minimally invasive procedures, where the operative field is limited, selecting an appropriate anti-adhesion adjunctive device with practical surgical usability has become increasingly important.
Why Can Adhesions Still Occur After Minimally Invasive Surgery?
Adhesion formation is a natural response during tissue healing and can occur throughout the body, most commonly after abdominal or pelvic surgery.
When the peritoneum or organ surfaces are injured, damaged tissues release fibrin, which functions like a biological glue to repair wounds. During this healing process, surrounding tissues or organs may unintentionally stick together, leading to adhesion formation.
Although minimally invasive surgery involves smaller incisions, it still creates peritoneal trauma that activates the body’s repair mechanisms. As a result, the risk of postoperative adhesions remains present. Additionally, minimally invasive procedures frequently rely on electrosurgical instruments, which may cause thermal injury to surrounding tissues and further increase inflammation and adhesion risk.
Adhesions are generally irreversible. In severe cases involving bowel obstruction, chronic pain, or infertility, additional surgery may be required for adhesiolysis. Therefore, physicians and patients are encouraged to discuss adhesion prevention strategies before surgery, including the possible use of anti-adhesion barrier devices to support long-term postoperative quality of life.
The Evolution of Anti-Adhesion Medical Devices
To reduce adhesion-related complications, anti-adhesion barrier technologies have continuously evolved alongside surgical advancements.
Several types of anti-adhesion materials are currently used in clinical practice, each with distinct characteristics and applications.
| Type | Materials / Mechanism | Characteristics | Clinical Application Scenarios |
| Solid Barrier Films | Hyaluronic acid, Carboxymethylcellulose (CMC), etc. | Directly covers localized wounds to form a physical barrier. | Suitable for traditional open surgeries. The confined space in minimally invasive surgery creates a very high technical threshold for application. Additionally, it is less suitable for large or irregular wounds. |
| Gel-Type Barriers | Hyaluronic acid derivatives, Cross-linked peptide hydrogels. | Easier to apply than films; can cover localized, irregular areas. | More suitable for minimally invasive surgeries with small, irregular wounds. Its fluidity is limited, lacking comprehensive protection, and achieving even coating relies heavily on the operator’s skill. |
| Spray or Powder-Type Barriers | Polysaccharide microparticle powders, Sprayable hydrogels. | A newer form of medical device; easy to operate with a broader coverage area than gels. Some formulations also assist in hemostasis. | Suitable for both open and minimally invasive surgeries. Provides wide and even coverage, ideal for hard-to-reach dead spaces and minimally invasive wounds with extensive oozing. However, the spraying process may obstruct vision, and the risk of fogging the laparoscope lens must be monitored. |
| Liquid Anti-Adhesion Solutions (4% Icodextrin) | High-molecular-weight glucose polymer solution. | Can be used as an intraoperative irrigant and left in the peritoneal cavity postoperatively, providing broad coverage. | Highly suitable for minimally invasive surgeries. Excellent fluidity allows for broad and even protection, especially in deep pelvic regions or dead spaces. |
Most anti-adhesion materials are naturally absorbed and degraded by the body within approximately two weeks, depending on formulation and composition, and generally do not cause long-term foreign body retention concerns.
Clinical Situations Where Liquid Anti-Adhesion Solutions May Be Considered
Liquid anti-adhesion solutions, such as 4% icodextrin solution, offer several notable characteristics:
- Broad Coverage: The fluid can distribute throughout the abdominal and pelvic cavity, reaching difficult surgical angles and anatomical dead spaces commonly encountered in minimally invasive surgery.
- Hydroflotation Effect: Studies suggest that 4% icodextrin solution may remain within the abdominal cavity for approximately 3–7 days, while the critical tissue healing period typically lasts 3–5 days. During this period, organs remain temporarily separated, reducing fibrin bridge formation between tissues.[ii]
1. Gynecologic Surgical Applications
According to U.S. FDA-approved information, 4% icodextrin solution may be used as an adjunctive device to reduce postoperative adhesion risk following gynecologic laparoscopic surgery.
Common clinical applications include:
- Endometriosis surgery
- Ovarian cystectomy
- Pelvic adhesiolysis
- Management of multiple peritoneal injuries
- Deep pelvic minimally invasive surgery
2. General Surgery and Colorectal Surgery
Because the intestines are highly mobile within the abdominal cavity, broad anti-adhesion protection may be beneficial in procedures involving extensive bowel manipulation or prior abdominal surgeries.
Clinical situations may include:
- Severe bowel adhesion separation surgery
- Patients with previous abdominal surgery history and recurrent bowel obstruction risk
3. Trauma and Extensive Abdominal Surgery
Liquid anti-adhesion solutions may also be considered in emergency surgeries involving major abdominal trauma, blunt injury, or intra-abdominal bleeding.
Choosing Anti-Adhesion Devices Should Be Individualized
Currently, no single anti-adhesion product is suitable for every surgical scenario.
Different barrier materials possess unique physical characteristics and clinical indications. Product selection should not rely solely on cost considerations. Instead, physicians and patients are encouraged to discuss surgical approach, operative complexity, and individual risk factors before determining the most appropriate adhesion prevention strategy.
As minimally invasive surgery continues to evolve, anti-adhesion technologies are also advancing toward solutions that better address complex anatomy and surgical practicality. For procedures requiring broad coverage and deep pelvic protection, liquid anti-adhesion solutions remain an important option in modern minimally invasive surgery.
Disclaimer:
This article is intended for educational and informational purposes only and does not constitute medical advice. All medical decisions should be made by qualified healthcare professionals based on individual clinical conditions.
[i] Menzies D Ann R Coll Surg Engl 1993
[ii] DiZerega GS, et al. “Adept Adhesion Reduction Solution: 4% Icodextrin”. Expert Review of Medical Devices
