{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:23:09Z","timestamp":1784910189945,"version":"3.55.0"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm11061476","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T12:35:37Z","timestamp":1646742937000},"page":"1476","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["The Future of Adhesion Prophylaxis Trials in Abdominal Surgery: An Expert Global Consensus"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5759-9745","authenticated-orcid":false,"given":"Rudy Leon","family":"De Wilde","sequence":"first","affiliation":[{"name":"University Hospital for Gynecology, Carl von Ossietzky University, 26121 Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7795-7749","authenticated-orcid":false,"given":"Rajesh","family":"Devassy","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Gynecological Minimal Access Surgery and Oncology, Dubai London Clinic & Specialty Hospital, Dubai 3371500, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4012-7968","authenticated-orcid":false,"given":"Richard P. 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Today"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/SLA.0000000000002175","article-title":"Multicenter Observational Study of Adhesion Formation After Open-and Laparoscopic Surgery for Colorectal Cancer","volume":"267","author":"Stommel","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0140-6736(19)32636-4","article-title":"Adhesion-related readmissions after open and laparoscopic surgery: A retrospective cohort study (SCAR update)","volume":"395","author":"Krielen","year":"2020","journal-title":"Lancet"},{"key":"ref_4","first-page":"CD000475","article-title":"Barrier agents for adhesion prevention after gynaecological surgery","volume":"3","author":"Ahmad","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s10397-007-0333-2","article-title":"Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. Part 2 Steps to Reduce Adhesions","volume":"4","author":"DeWilde","year":"2007","journal-title":"Gynecol. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.21037\/atm.2020.02.53","article-title":"Chinese expert consensus on the prevention of abdominal pelvic adhesions after gynecological tumor surgeries","volume":"8","author":"Lang","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1111\/iju.14229","article-title":"Interstitial cystitis\/bladder pain syndrome: The evolving landscape, animal models and future perspectives","volume":"27","author":"Akiyama","year":"2020","journal-title":"Int. J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/0140-6736(90)91125-T","article-title":"Peritoneal fibrinolytic activity and intra-abdominal adhesions","volume":"335","author":"Vipond","year":"1990","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1093\/humrep\/16.8.1548","article-title":"Peritoneal closure\u2014To close or not to close","volume":"16","author":"Cheong","year":"2001","journal-title":"Hum. Reprod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0029-7844(95)00175-Q","article-title":"Reduction of ovarian adhesions by the use of Interceed. Ovarian Adhesion Study Group","volume":"86","author":"Franklin","year":"1995","journal-title":"Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1471-0528.1994.tb13621.x","article-title":"The value of an absorbable adhesion barrier, Interceed, in the prevention of adhesion reformation following microsurgical adhesiolysis","volume":"101","author":"Li","year":"1994","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1308\/003588406X114730","article-title":"Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: From the multicentre ARIEL Registry","volume":"88","author":"Menzies","year":"2006","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/107175401300002694","article-title":"Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin","volume":"8","author":"Hosie","year":"2001","journal-title":"Drug Deliv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1093\/humrep\/17.4.1031","article-title":"A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery","volume":"17","author":"Verco","year":"2002","journal-title":"Hum. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s10397-005-0126-4","article-title":"Use of icodextrin 4% solution in the reduction of adhesion formation after gynaecological surgery","volume":"2","author":"Sutton","year":"2005","journal-title":"Gynecol. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3029264","DOI":"10.1155\/2016\/3029264","article-title":"Use of Modified Polysaccharide 4DryField PH for Adhesion Prevention and Hemostasis in Gynecological Surgery: A Two-Center Observational Study by Second-Look Laparoscopy","volume":"2016","author":"Korell","year":"2016","journal-title":"BioMed Res. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/j.1463-1318.2007.01343.x","article-title":"Postoperative intraperitoneal adhesion pathophysiology","volume":"9","author":"Duron","year":"2007","journal-title":"Colorectal. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Surgeons (2013). Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: A committee opinion. Fertil. Steril., 99, 1550\u20131555.","DOI":"10.1016\/j.fertnstert.2013.02.031"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1177\/1933719114522550","article-title":"Advances in the Pathogenesis of Adhesion Development: The Role of Oxidative Stress","volume":"21","author":"Awonuga","year":"2014","journal-title":"Reprod. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.fertnstert.2015.06.041","article-title":"Shifting anaerobic to aerobic metabolism stimulates apoptosis through modulation of redox balance: Potential intervention in the pathogenesis of postoperative adhesions","volume":"104","author":"Fletcher","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.fertnstert.2016.08.012","article-title":"Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue","volume":"106","author":"Koninckx","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1177\/1933719118789511","article-title":"Evitar (l-Alanyl-l-Glutamine) Regulates Key Signaling Molecules in the Pathogenesis of Postoperative Tissue Fibrosis","volume":"26","author":"Robertson","year":"2019","journal-title":"Reprod. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1038\/s41395-018-0158-9","article-title":"A Shared Decision Approach to Chronic Abdominal Pain Based on Cine-MRI: A Prospective Cohort Study","volume":"113","author":"Stommel","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0020-7292(97)00247-6","article-title":"Reproducibility of the revised American Fertility Society classification of endometriosis using laparoscopy or laparotomy","volume":"60","author":"Lin","year":"1998","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1007\/s00464-020-07621-5","article-title":"Clinical adhesion score (CLAS): Development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery","volume":"35","author":"Lier","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1177\/1553350610379869","article-title":"Adhesion prevention and reduction: Current status and future recommendations of a multinational interdisciplinary consensus conference","volume":"17","author":"Diamond","year":"2010","journal-title":"Surg. 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