Even though awareness of this problem is widely agreed among surgeons and gynaecologists, uncertainty still exists about the treatment and prophylactic strategies for dealing with adhesions [144]. A recent national survey among Dutch surgeons and surgical Selleck Rigosertib trainees

[145] showed that underestimation of the extent and impact of adhesions resulted in low knowledge scores and Lower scores correlated with more uncertainty about indications for antiadhesive agents which, in turn, correlated with never having used any of these agents. Several articles on adhesion barriers have been published but several controversies such as the effectiveness of available agents and their indication in general surgical patients still exist. Most of the available literature is based on gynecologic patients. For general surgical patients no recommendations or guidelines Selinexor cost exist. Any prevention strategy should be safe, effective, practical, selleckchem and cost effective. A combination of prevention strategies might be more effective [146]. The prevention strategies can be grouped into 4 categories: general principles, surgical techniques, mechanical barriers, and chemical agents. General principles Intraoperative techniques such as avoiding unnecessary peritoneal dissection, avoiding spillage of intestinal contents or gallstones [147], and the use of starch-free gloves [148, 149] are basic principles

that should be applied to all patients. In a large systematic review [150], the closure of the peritoneum, spillage and retention of gallstones during cholecystectomy, and the use of starched gloves all seems to increase the risk

for adhesion formation. Surgical techniques Anidulafungin (LY303366) The surgical approach (open vs laparoscopic surgery) plays an important role in the development of adhesive SBO. In the long term follow up study from Fevang et al. [151] the surgical treatment itself decreased the risk of future admissions for ASBO, even though the risk of new surgically treated ASBO episodes was the same regardless of the method of treatment (surgical vs conservative). The technique of the procedure (open vs. laparoscopic) also seems to play a major role in the development of adhesive SBO. The incidence was 7.1% in open cholecystectomies vs. 0.2% in laparoscopic; 15.6% in open total abdominal hysterectomies vs. 0.0% in laparoscopic; and 23.9% in open adnexal operations vs. 0.0% in laparoscopic. There was no difference in SBO following laparoscopic or open appendectomies (1.4% vs. 1.3%) [152]. In most abdominal procedures the laparoscopic approach is associated with a significantly lower incidence of adhesive SBO or adhesion-related re-admission. In a collective review of the literature the incidence of adhesion-related re-admissions was 7.1% in open versus 0.2% in laparoscopic cholecystectomies, 9.5% in open versus 4.3% in laparoscopic colectomy, 15.