Spray-On Barrier Curbs Laparoscopic Surgical Adhesions

A spray-on combination of hyaluronic acid (HA) and cellulose might help reduce postoperative adhesions, according to a new study.

Researchers at Thomas Jefferson University (Philadelphia, PA, USA), Wayne State University School of Medicine (Wayne State, Detroit, MI, USA), and other institutions conducted a multicenter, randomized, reviewer-blinded trial involving 41 women undergoing laparoscopic myomectomy. The participants were randomized to treatment with (21 patients) or without (20 patients) use of Sepraspray Adhesion Barrier, a modified HA and carboxymethylcellulose powder. The main outcome measures were postoperative adhesions development, as assessed at early second-look laparoscopy.

The results showed that median operative time was increased by only 3 minutes in the treatment group. Both groups had increased adhesions associated with the creation of one or more uterine incisions at the initial laparoscopy, but for anterior and anterior uterine surfaces the increases tended to be smaller in the spray group. This was also true of the uterus as a whole; the increase in the score was more than twice as large in the control group as in the spray group. The spray group was also more likely to have either side of the uterus free of dense adhesions (95% versus 70%). There was no overall between-group difference in the number of patients with adverse events, nor were any adverse events directly linked to use of the spray. The study was published in the August 2011 issue of Fertility and Sterility.

“There is a tremendous medical need for development of adjuvants to reduce postoperative adhesions, over and above the benefits achievable by the use of meticulous surgical technique,” said study coauthor Michael Diamond, MD, of Wayne State, who is also a consultant for Genzyme Corporation (Cambridge, MA, USA), the manufacturer of the Sepraspray Adhesion Barrier.

Postoperative intra-abdominal and pelvic adhesions involve the nonanatomic connection of fibrous tissue between normal peritoneal surfaces. Adhesions are a leading cause of infertility, chronic pelvic pain, and intestinal obstruction. Although not commonly recognized, the incidence ranges between 55% and 95% after abdominal or pelvic surgery. It is generally considered that some people are more prone to develop postoperative adhesions than are others; unfortunately, there is no available marker to predict the occurrence, extent, and severity of adhesions preoperatively. Additionally, there are no available serum markers or imaging studies that are able to predict the incidence, severity, or extent of adhesions.

Related Links:
Thomas Jefferson University
Wayne State University School of Medicine
Genzyme Corporation