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Adhesion Prevention During Laparotomy: Long-Term Follow-up of a Randomized Clinical Trial

van der Wal, J. B. C. MD, PhD*; Iordens, G. I. T. MD*; Vrijland, W. W. MD, PhD; van Veen, R. N. MD, PhD; Lange, J. MD, PhD*; Jeekel, J. MD, PhD*

doi: 10.1097/SLA.0b013e318217e99c
Randomized Controlled Trials
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Objective: The objective of the study was to determine the long-term effect of the use of a hyaluronic acid-carboxymethylcellulose membrane (Seprafilm) on the incidence of adhesions and subsequent small-bowel obstruction and chronic abdominal complaints after colorectal surgery (Hartmann's procedure).

Background: Adhesions occur frequently after abdominal surgery and are the most common cause of bowel obstruction, chronic abdominal pain, and infertility. The risk for adhesion-related readmission in the first 10 years after colorectal surgery is as high as 30%. To reduce the formation of adhesions, a mechanical barrier composed of hyaluronic acid and carboxymethylcellulose was developed, to prevent adherence of tissues after abdominal surgery. Long-term results concerning the incidence of small-bowel obstruction and chronic abdominal pain are lacking.

Methods: Between April 1996 and September 1998, 71 patients requiring Hartmann's procedure for sigmoid diverticulitis or obstructed rectosigmoid were randomized to either intraperitoneal placement of Seprafilm under the midline and in the pelvis or as a control. Direct visual evaluation of the incidence and severity of adhesions was performed laparoscopically in 42 patients at second-stage surgery for restoration of the continuity of the colon. The results of this study were published in 2002. In 2006, the patients' general practitioners were interviewed by means of a questionnaire concerning their patients' health. The patients who were still alive were interviewed and asked to fill out 2 questionnaires concerning pain and quality of life (VAS-pain score, EQ-5D, and SF-36). In 2009, the medical records of the patients were evaluated for adhesion-related hospital re-admissions.

Results: Of the 42 evaluated patients, 35 (16 in the Seprafilm group, 19 in the control group) could be enrolled in the long-term follow-up. Median follow-up was 126 months (range 41–148) for the Seprafilm group and 128 months (range 49–149) months for the control group. Incidence of chronic (3 months or longer existing) abdominal complaints was significantly lower in the Seprafilm group compared with controls (35.3% vs. 77.8%, respectively; P = 0.018). Incidence of small-bowel obstruction showed no significant difference in favor of the Seprafilm group; no small-bowel obstructions occurred in the Seprafilm group, whereas in the control group 2 cases of small-bowel obstruction were found to have occurred. Evaluation of the quality of life questionnaires did not reveal significant differences between the 2 groups.

Conclusions: In Hartmann's procedure, Seprafilm placement does not provide protection against small-bowel obstruction. Incidence of chronic abdominal complaints is significantly lower after use of Seprafilm.

A long-term follow-up of a clinical trial on the usage of Hyaluronic Acid-Carboxymethylcellulose membrane (Seprafilm) in Hartmann's procedure was performed. Of the 42 patients in the original study, 35 (16 Seprafilm group, 19 control group) could be enrolled in the follow-up. Incidence of chronic abdominal complaints was significantly lower in the Seprafilm group compared to controls (35.3% vs 77.8% respectively; p = 0.018). Incidence of small bowel obstruction showed no significant difference (0 vs 2).

*Erasmus Medical Center

Sint Fransiscus Hospital, and

Ikazia Hospital Rotterdam, Rotterdam, The Netherlands.

Reprints: J. Jeekel, MD, PhD, Department of Neuroscience, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. E-mail: j.jeekel@erasmusmc.nl.

© 2011 Lippincott Williams & Wilkins, Inc.