Efficacy of complex preventive approach to postoperative pelvic adhesions

Aim: to assess the efficacy of complex prevention of postoperative pelvic adhesions. Patients and Methods: this open-label comparative prospective study involved 222 women of reproductive age with gynecological diseases, tuboperitoneal infertility, and pelvic adhesions stage 1–2 diagnosed laparoscopically (according to the R-AFS classification). In the study group (n=112), the prevention of postoperative adhesions was performed using the authors’ algorithm that included separation of adhesions using HARMONIC ultrasonic energy, intra-abdominal injection of anti-adhesive agent based on a natural polymer of carboxymethyl cellulose, and IM sodium deoxyribonucleate from post-op day 1 with a 24-hour interval for 10 days. In the comparison group (n=110), separation of adhesions was performed using bipolar energy, and standard preventive measures were applied. The rate and severity of postoperative adhesions (via second-look laparoscopy), the recovery of reproductive function (by the fact of intrauterine pregnancy), and the quality of life (using MOS SF-36 and WHQ questionnaires) were evaluated. The levels of CD20+, CD4+, CD8+, and CD56+ lymphocytes cells were measured preoperatively and on postoperative days 3 and 14. Follow-up was 12 months. Results: authors’ preventive algorithm activates immunoregulatory mechanisms of cellular humoral immunity, reduces the rate (by 4.5 times, p