Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial.

Adhesions after abdominal surgery are abnormal attachments between tissues or organs. The formation of adhesions may result from mechanical peritoneal damage, intraabdominal ischemia, and the presence of foreign materials in the abdominal cavity such as glove powder, microorganisms, gauze lint, sutures, and prosthetic mesh. 1–3 Adhesions occur in 68% to 100% of patients undergoing one or more laparotomies. 1,3,4 Although intraabdominal adhesions are asymptomatic in most patients, adhesions can cause intestinal obstruction, chronic abdominal pain, infertility, and an increased rate of complications during subsequent operations. 5 Adhesions are the most common cause of intestinal obstructions in the Western world. 4 Another clinical problem, possibly caused by adhesions, is chronic abdominal pain. 6,7 Infertility is a known sequela of intraabdominal adhesions. 8,9 The increased complication rate can be caused by a longer duration of surgery, postoperative bleeding, and a higher risk of bowel perforations. 5,10 The incidence of these complications increases with the number of previous laparotomies or laparoscopies. 11 Substantial costs are associated with adhesion-related clinical problems. 12,13 In 1988, hospital admissions for adhesiolysis were responsible for an estimated $1.180 million in expenditures in the United States. 14,15 Prevention of the formation of adhesions during surgery entails reducing surgical trauma and avoiding contamination of the abdominal cavity with foreign materials. Other means have been sought to reduce postoperative adhesions. Theoretically, a mechanical barrier between adjacent tissues could provide a way of reducing adhesion formation by preventing tissues and organs from adhering to each other. Regeneration of damaged peritoneum is completed within 7 days after surgical trauma. 16 To avoid the persistent presence of foreign material within the abdominal cavity and still attain the intended effect, a temporary barrier not resolving within 7 days is preferable. HAL-F Bioresorbable Membrane (Seprafilm; Genzyme Corp., Cambridge, MA) was developed to serve as a mechanical barrier between surgically damaged tissues. Resorption of this biodegradable membrane starts after 7 days. In animal studies and in one randomized clinical trial, it has been shown that Seprafilm reduces the incidence, extent, and severity of postsurgical adhesions. 17 The incidence of adhesions after (partial) colectomy is high, so this procedure provides a suitable model for studies of adhesion prevention. 18,19 A Hartmann procedure with second-stage restoration of the continuity of the colon was chosen as a model to examine the effectiveness of the Seprafilm membrane. The aim of this prospective clinical randomized multicenter trial was to assess the effectiveness of this antiadhesions membrane in reducing the number, incidence, and severity of adhesions in patients with diverticulitis or obstruction of the rectosigmoid.