A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy

• Published in: Surgery today (Tokyo, Japan) Vol. 40; no. 3; pp. 223 - 227
• Main Authors: Kawamura, Hideki, Yokota, Ryoichi, Yokota, Kentaro, Watarai, Hiroshi, Tsunoda, Yoshihiko, Yamagami, Hideki, Hata, Tsunetake, Tanaka, Koichi, Masuko, Hiroyuki, Ishizu, Hiroyuki, Okada, Kuniaki, Adachi, Takehiko, Kondo, Yukifumi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-03-2010
• Subjects: Aged; Biocompatible Materials; Carboxymethylcellulose Sodium; Female; Gastrectomy - adverse effects; Gastroenterostomy; Humans; Hyaluronic Acid; Intestinal Obstruction - etiology; Intestinal Obstruction - prevention & control; Intestine, Small; Male; Medicine; Medicine & Public Health; Membranes, Artificial; Middle Aged; Original Article; Retrospective Studies; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Tissue Adhesions - etiology; Tissue Adhesions - prevention & control; Gastrectomy; Adhesive obstruction; Adhesion; Bioresorbable membrane
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-008-4059-1

Purpose
It is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm).
Methods
The subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (
n
= 169), but it was used in all patients operated on from May 2003 onward (
n
= 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group.
Results
The cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (
P
= 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (
P
= 0.049).
Conclusion
In this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.