Page 37 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
Hyaluronic acid and carboxymethylcellulose (Seprafilm®)
Seprafilm® (Bard) is a transparent and resorbable membrane consisting of
the combination of sodium hyaluronic acid and carboxymethylcellulose.
This material is able to separate mechanically two opposing tissue areas. 2 Seprafilm® is biologically resorbable and degrades after 7 days under physiological conditions [38, 123]. In a meta-analysis it was concluded
that hyaluronate CMC significantly reduced the incidence of site-specific adhesions and reduced the incidence of small bowel obstruction [114].
The adhesion score was also reduced in a trial of gynecological surgery,
but not for colorectal surgery. A major disadvantage has been shown in
one trial with low risk of bias: wrapping the suture or staple line of the
bowel anastomosis might increase the risk of anastomotic leakage [114,
124]. Furthermore, due to the high fragility of this material, its practical application especially in minimally invasive surgery is limited [38, 109,
125, 126].
Oxidized regenerated cellulose (Interceed®)
Interceed® (Ethicon) is a netlike membrane which is easy to handle even in laparoscopic surgery. After application on the injured peritoneum it swells and becomes a gel. The cellulose breaks down to monosaccharides and will then be completely resorbed within 4 days to 2 weeks after insertion [114, 127]. A meta-analysis in 2014 reported data from 11 trials (1184 patients), all with gynecological patients. Information about the incidence of small bowel obstruction was therefore not included. The authors concluded that oxidized regenerated cellulose significantly reduced the site-specific adhesions and adhesions scores [114]. The Cochrane Database reports comparable results in an analysis performed in 2015, although after laparotomy the amount of adhesions was not reduced [128, 129]. More recently it has been shown in a small prospective randomized study that using oxidized regenerated cellulose in laparoscopic surgery is valid and technically safe [130].
Suprathel® and SupraSeal®
Suprathel® (PolyMedics Innovations) is a resorbable membrane based on poly-DL-lactic acid combined with trimethylencarbonate and e-caprolactone. This material is already in clinical use as a successful
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