Page 64 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 3
induce adhesion formation [17]. Therefore surgeons should be aiming for meticulous surgery and minimal contamination with foreign materials of the abdominal area. However, such methods only diminish and certainly do not prevent adhesion formation completely. Additionally use of an adhesion reduction agent might be essential.
Adhesion reduction agents can generally be divided in pharmacological agents, site-specific physical barriers and broad coverage physical barriers. Potential pharmacological agents like fibrinolytics, steroids and NSAIDs were shown to be effective in experimental studies but no clinical studies have shown adhesion reduction benefits and these compounds may be associated with side effects like abdominal haemorrhage and impaired wound healing [15, 18, 19]. In contrast several physical barriers are approved and available on the market as adhesion reduction agents. Nevertheless their success in safety, costs and effectiveness varied [18, 20-25]. A recent study revealed the results of 10-year follow-up after Hartmann’s procedure and the use of Seprafilm. It was shown that Seprafilm did not protect against small-bowel obstruction, but the incidence of chronic abdominal complaints was significantly lower compared with controls. [26]. One of the currently used barriers, icodextrin 4%, is a broad coverage agent working on the principle of separating damaged surfaces by hydroflotation. In several studies involving gynaecological surgery icodextrin 4% has been proven to be effective and in the first double blind RCT for an adhesion reduction agent a significant favourable effect was found [10]. Nonetheless, other authors stated that evidence is far from conclusive and further studies are awaited [27].
In order to find an effective and feasible adhesion prevention agent a new adhesion prevention barrier based on polyvinyl-alcohol was developed [7]. The results were very promising, however the gel appeared to slip away from the trauma site too easily. To improve the quality of adherence to the abdominal wall carboxymethylcellulose was added resulting in PVA/CMC gel [9]. In the first experimental studies the new hydrogel seemed to be a feasible and effective adhesion prevention agent, although still few data is available [7-9].
In experiment one the efficacy of the new adhesion prevention gel was evaluated in different dosages, resulting in a significant reduction of
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