Table 3

Consensus proposals: actions to reduce adhesions

1.

Adhesions need to be recognised as the most frequent complication of abdominal surgery.

2.

Surgeons, other healthcare workers, budget holders and policy makers need to increase their awareness and understanding of adhesions and the associated healthcare burden and costs and take active steps to reduce this.

3.

Patients need to be informed of the risk of adhesions, given that adhesions are now the most frequent complication of abdominal surgery.

4.

Surgeons who do not advise of the risk of adhesions may put themselves at risk of claims for medical negligence.

5.

Surgeons have a duty of care to protect patients by providing the best possible standards of care—which should include taking steps to reduce adhesion formation.

6.

Surgeons should adopt a routine adhesion-reduction strategy, at least in surgery at high risk for adhesions, such as:

- Ovarian surgery

- Endometriosis surgery

- Tubal surgery

- Myomectomy

- Adhesiolysis

7.

Good surgical technique is fundamental to any adhesion-reduction strategy—see Table  1

8.

Surgeons should consider the use of adhesion-reduction agents as part of their adhesion-reduction strategy, giving special consideration to agents with data to support safety in routine abdominopelvic surgery and efficacy in reducing adhesions. The practicality and ease of use of agents, as well as the cost of any agent, will influence their acceptability in routine practice.

9.

Further research to understand the impact that adhesion-reduction agents have on clinical outcomes will be important.

10.

Research towards more effective preventative agents should be encouraged—including the use of combinations of agents to prevent the formation of de novo adhesions, as well as adhesion reformation.

11.

Surgeons need to act now to reduce adhesions and fulfil their duty of care to patients.