A new method of adhesion prevention

Adhesions commonly occur after surgery particularly after laparotomy. Although products have been designed to decrease the incidence and severity of adhesions following laparotomy (Becker et al; Salum et al), no product has been proven satisfactory in a laparoscopic setting. In order to reduce postoperative adhesions a Japanese company developed a laparoscopically applicable bio-absorbable spray adhesion barrier system. Suto and coworkers performed a multicenter randomized controlled trial in which 60 patients had application of the new compound and 62 more served as controlled. The model chosen for adhesion assessment was identical to the one that we used in our landmark Seprafilm® (Fazio et al). In a very analogous manner to our Seprafilm® study adhesions at second look surgery were reduced by approximately 50% in the treatment as compared to the control group (90.7% v. 52.7%, respectively; p<0.001). In addition both the extent and severity of adhesions were also reduced in the treatment group. Specifically, the incidence of widespread grade 2 or 3 adhesions were noted in 79.1% of the control group but only 38.2% of the treatment group (p<0.001). Moreover, the overall incidence of grade 2 or 3 adhesions was also lower in the treatment group at 47.3 versus 88.4%, respectively (p<0.001). There were no differences in the incidences of adverse outcomes. One interesting finding was the surprisingly high incidence of adhesions in the control group given the fact that laparoscopy was in and of itself associated with a significant reduction in adhesions. Nonetheless, regardless of the baseline incidence of adhesions were reduced in terms of extent, severity, and incidence by using this laparoscopically applicable compound. I am very keen to see these results reproduced in other larger randomized controlled trials. Regardless of how low the incidence of adhesions might be after laparoscopic colorectal surgery, further reduction certainly seems beneficial.