Page 36 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 2
Polyethylene-glycol-based fluid (PGB) (SprayShield® Spraygel®)
SprayShield® (Covidien), formerly Spraygel® (Confluent Surgical Inc.), is a two-component system consisting of two different polyethylene-glycol- based fluids. In order to facilitate the identification of already treated areas, the barrier is coloured in blue. Within seconds after application, this gel adheres to the application site and effectively covers the adhesion-supporting wound areas [38, 112]. It is cleared via the kidneys in 7-8 days. In a clinical trial with a small number of patients, Spraygel® had already revealed good adhesion-preventive effects [113]. In a meta- analysis it was concluded that PGB significantly reduced adhesion scores both in gynaecological surgery and in one trial of colorectal surgery with low risk of bias. However, the authors gave notice of a high risk of random error in the included studies [114].
Fibrin glue (Tisseel VH® and Tissucol®)
The biological products Tisseel VH® and Tissucol® (Baxter) are well known and widely used in clinical practice to achieve hemostasis, to seal and agglutinate tissue defects and to promote wound healing [90, 115]. According to the pathogenesis of adhesions, application of fibrin glue at the traumatized peritoneal surfaces should increase adhesion formation. Possibly, fibrin glue application confines fibrin deposition and averts the development of attachments between opposing tissue surfaces. In animal studies, the use of fibrin glue has been shown to decrease adhesion formation and reformation but clinical data are limited [90, 115-118]. Current research with fibrin glue is more focused on fixation and haemostasis instead of adhesion prevention [119].
Solid barriers
A wide range of natural and synthetic materials is used either as absorbable or non-absorbable foils or membranes. Solid barriers have to be directly applied to the damaged surface and keep the tissues separated until the reepitheliazation process has been completed [38, 120]. A disadvantage of a solid barrier is that the surgeon has to predict were adhesions will be formed. In the case of an adhesion out of the direct operation field for example, this is almost impossible [44, 121, 122].
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