Adhesion barrier

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An adhesion barrier is a medical implant that can be used to reduce abnormal internal scarring (adhesions) following surgery by separating the internal tissues and organs while they heal.

Prior to the availability of adhesion barriers, adhesions were documented to be an almost unavoidable consequence of abdominal and pelvic surgery. These adhesions can lead to significant post-surgical morbidity including bowel obstruction, infertility, and chronic pelvic pain or chronic abdominal pain.

Surgeons and healthcare professionals developed several methods for minimizing tissue injury in order to minimize the formation of adhesions. However, even an experienced surgeon using advanced techniques may not be able to prevent the formation of adhesions following surgery without the aid of an adhesion barrier. Consequently, many surgeons have come to rely upon adhesion barriers for adhesion prevention following abdominal and pelvic surgery.

Description

Adhesion barriers are physical films, fabrics, gels or other materials that are applied between layers of tissues at the end of a surgery before the incision site is closed. While in place, the adhesion barrier acts as a physical barrier to separates traumatized tissue surfaces so that they do not adhere to one another while the tissue surfaces heal. Once the tissue surfaces heal, which is usually between 3 and 7 days, the barrier dissolves and is absorbed by the body.

Commercial availability

The first commercially available adhesion barrier it seems was Cargile Membrane, a preserved peritoneal membrane of the Danish Ox.^[1] Marketed by Johnson & Johnson around 1904, it was still avaialble in the early 1990s. In the United States, Interceed,^[2] Seprafilm^[3] and Adept^[4] are the three products approved by FDA for use as an adhesion barrier after abdominal or pelvic surgery.

Seprafilm (made by Genzyme) is a clear, sticky film composed of chemically modified sugars, some of which occur naturally in the human body. It sticks to the tissues to which it is applied and is slowly absorbed into the body over a period of seven days. It is approved for use in certain types of pelvic or abdominal surgery.

Interceed (made by Johnson & Johnson) is a knitted fabric composed of a modified cellulose that swells and eventually gels after being placed on the injured site, and, like Seprafilm, forms a barrier and then is slowly absorbed over a period of days. It is approved for use in pelvic surgery. Although it is technically possible to apply either Seprafilm and Interceed laparoscopically, neither product is approved for this use in the USA.

Adept (Baxter) is a solution of Icodextrin that when instilled in a large volume causes organs to float apart, reducing the possibility of attachment.

Other sources

A number of adhesion barriers are available outside of the United States including Hyalobarrier,^[5] SprayShield,^[6] PrevAdh^[7] and INTERCOAT.^[8] Several products licensed for other uses are used "off-label" in the USA for adhesion prevention including Evicel, Surgiwrap, CoSeal and Preclude.

Products available for adhesion prevention outside the abdominal and pelvic abdominal cavities inside or outside the USA include ADCON Gel^[9] (spine and tendon surgery), Sepragel ENT, INCERT^[10] (spine), Tenoglide (tendon), Oxiplex^[11] (Medishield) (spine) and REPEL CV (Cardiac).

References

Further reading

• Becker, JM; Dayton, MT; Fazio, VW; Beck, DE; Stryker, SJ; Wexner, SD; Wolff, BG; Roberts, PL et al (1996). "Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: A prospective, randomized, double-blind multicenter study". Journal of the American College of Surgeons 183 (4): 297–306. PMID 8843257. 
• Diamond, MP (1996). "Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): A blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group". Fertility and sterility 66 (6): 904–10. PMID 8941053. 
• Wiseman, DM; Trout, JR; Franklin, RR; Diamond, MP (1999). "Metaanalysis of the safety and efficacy of an adhesion barrier (Interceed TC7) in laparotomy". The Journal of reproductive medicine 44 (4): 325–31. PMID 10319300. 

External links

• Comprehensive review of anti-adhesion products - International Adhesions Society
• About Seprafilm
• Gynecare Interceed Absorbable Adhesion Barrier
• ADEPT Adhesion Reduction Solution (4% Icodextrin)