Les adhérences pelviennes sont à la fois une source d’infertilité, d’échecs de la chirurgie de l’infertilité, de douleurs pelviennes chroniques, d’occlusion sur bride et de complication en cas de réintervention. Leur fréquence est souvent sous-estimée car leur répercussion clinique est décalée dans le temps. Leur prévention repose d’abord sur une technique chirurgicale appliquant en cœlioscopie les règles de la microchirurgie, incluant une manipulation atraumatique, une hémostase soigneuse – mais une limitation de la coagulation – et une irrigation du champ opératoire. L’insufflation avec du CO2 humidifié et réchauffé est aussi un élément important. La prévention par des agents pharmacologiques généraux n’a pas été prouvée. La prévention par des agents locaux type barrières solides, liquides ou gel manquent encore de preuve irréfutable de leur efficacité, et celle-là semble de toute façon modeste ; aussi ne doivent-ils venir qu’en complément d’une technique chirurgicale rigoureuse. Il est surtout nécessaire que des études cliniques plus importantes soient réalisées pour évaluer leur niveau d’efficacité.
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Les adhérences pelviennes : impact et prévention
Juil 09 2014 Rédaction-
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