Abstract
Postoperative adhesions are the most frequent complication of peritoneal surgery, causing small bowel obstruction, female infertility and chronic pain. This pilot study assessed the efficacy of a sprayable polyethylene glycol (PEG) barrier in the prevention of de novo adhesions. 16 patients undergoing laparoscopic gynecological surgery were randomly assigned by shuffled sealed envelopes to receive either the adhesion barrier or no adhesion prevention. Incidence and severity of adhesions were scored at eight sites in the pelvis and reassessed by second look laparoscopy. Adhesion prevention was considered successful if no de novo adhesion were found at second look laparoscopy. One patient was excluded before randomization. Nine patients were randomized to treatment and six patients to control group. De novo adhesions were found in 0/9 patients who received the PEG barrier compared to 4/6 without adhesion prevention (0% vs. 67%, P = 0.01). Reduction in adhesion score was significantly greater in patients receiving PEG barrier (−2.6 vs. −0.06, P = 0.03). Meta-analysis of three randomized trials demonstrated that PEG barrier reduces the incidence of adhesions (odds ratio [OR] = 0.27; 95% CI 0.11–0.67). From this study, PEG barrier seems effective in reducing postoperative formation of de novo adhesions.
Highlights
Adhesions develop after gynecological surgery in the pelvic cavity in almost all cases and cause significant morbidity [1]
There were no significant differences between the polyethylene glycol (PEG) and control group at index laparoscopy in age, type of surgical procedure, history of prior surgery, Chlamydia serology and smoking status at baseline (Table 2)
There was a non-significant trend towards more sites covered with adhesions (5.1±2.3 vs. 3± 2.2; P=0.10) and higher Local Adhesion Barrier Scoring System (LABS) score (3.7±2.8 vs. 2.4±3.0; P=0.40) in the PEG group (Table 3)
Summary
Adhesions develop after gynecological surgery in the pelvic cavity in almost all cases and cause significant morbidity [1]. In a large population-based study of gynecological pelvic surgery, the readmission rate directly or probably related to adhesions was 13.9%, and the introduction of less invasive techniques, such as laparoscopy, did not seem to reduce this adhesion related morbidity [2]. Adhesion barriers or anti-adhesive agents are needed because refinements in surgical techniques do not seem to be sufficient in reducing adhesion-related morbidity. An important drawback of the available membranous adhesions barriers is the difficulty of handling them during laparoscopic procedures. A sprayable polyethylene glycol (PEG) anti-adhesion barrier was developed for anti-adhesive purposes (SprayGel; Confluent Surgical Inc., Waltham, MA). The PEG adhesion barrier consists of two liquid precursor solutions that quickly react to form a hydrogel after being
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