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CC BY 4.0 · Surg J (N Y) 2019; 05(01): e28-e34
DOI: 10.1055/s-0039-1687857
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Significant Adhesion Reduction with 4DryField PH after Release of Adhesive Small Bowel Obstruction

Mouhannad Ahmad
1   Aller-Weser-Klinik, Verden (Aller), Germany
,
Fabio Crescenti
1   Aller-Weser-Klinik, Verden (Aller), Germany
› Author Affiliations
Further Information

Publication History

23 May 2018

14 March 2019

Publication Date:
10 May 2019 (online)

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Abstract

Background Peritoneal adhesions reoccur in up to 100% of cases, possibly causing complications like pain, secondary female infertility, and small bowel obstruction. The latter has a mortality rate of up to 15% during hospitalization. This study investigates if recurrence of peritoneal adhesions can be prevented by prophylactic use of the starch-based medical device 4DryField.

Methods The course of 40 patients with surgery for intestinal obstruction and, partially, second intervention was analyzed. In both operations, adhesion severity and extent were scored 0 (no adhesions) to III (massive/dense and vascular adhesions) and 0 (no adhesions) to III (extensive, covering more than approximately 25 × 25 cm), respectively. To prevent recurrence of adhesions all patients were treated with 4DryField gel (60 mL saline solution per 5 g powder), evenly distributed on the whole impaired intestine (including anastomoses) before abdominal closure. Follow-up was up to 1.5 years in a 3 to 6 months' interval.

Results Eight patients had relaparotomies on postoperative days 1 to 155. In the first operation, median adhesion severity score was III, median adhesion extent II. In redo-surgeries, significantly lower scores were detected (median adhesion severity: 0, p = 0.0003; median adhesion extent: 0, p = 0.0009). No adverse events related to the product were observed. One patient had later redo-surgery in another hospital due to recurrence of adhesions, one patient suffered from flatulence. All other patients were free of adhesion-related symptoms during follow-up.

Conclusion Based on the high severity of diseases and the significant reduction of adhesion severity and extent in redo-surgeries, 4DryField gel is a promising adjunct for adhesion prevention in bowel surgery. The favorable results should be confirmed in prospective randomized trials.

Keywords

ileus - intestinal obstruction - modified polysaccharide - barrier gel - adhesion prevention
 

  • References

  • 1 Menzies D, Ellis H. Intestinal obstruction from adhesions--how big is the problem?. Ann R Coll Surg Engl 1990; 72 (01) 60-63
    PubMedGoogle Scholar
  • 2 Attard JA, MacLean AR. Adhesive small bowel obstruction: epidemiology, biology and prevention. Can J Surg 2007; 50 (04) 291-300
    PubMedGoogle Scholar
  • 3 Reed KL, Fruin AB, Bishop-Bartolomei KK. , et al. Neurokinin-1 receptor and substance P messenger RNA levels increase during intraabdominal adhesion formation. J Surg Res 2002; 108 (01) 165-172
    CrossrefPubMedGoogle Scholar
  • 4 Weibel MA, Majno G. Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 1973; 126 (03) 345-353
    CrossrefPubMedGoogle Scholar
  • 5 Diamond MP. Incidence of postsurgical adhesions. In: diZerega G. , ed. Peritoneal Surgery. New York: Springer-Verlag; 2000: 217-220
    CrossrefGoogle Scholar
  • 6 Ellis H, Moran BJ, Thompson JN. , et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999; 353 (9163): 1476-1480
    CrossrefPubMedGoogle Scholar
  • 7 Parker MC, Ellis H, Moran BJ. , et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 2001; 44 (06) 822-829 , discussion 829–830
    CrossrefPubMedGoogle Scholar
  • 8 Luijendijk RW, de Lange DC, Wauters CC. , et al. Foreign material in postoperative adhesions. Ann Surg 1996; 223 (03) 242-248
    CrossrefPubMedGoogle Scholar
  • 9 Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V. Laparoscopic management of mechanical small bowel obstruction: are there predictors of success or failure?. Surg Endosc 2000; 14 (05) 478-483
    CrossrefPubMedGoogle Scholar
  • 10 Nieuwenhuijzen M, Reijnen MM, Kuijpers JH, van Goor H. Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review. Br J Surg 1998; 85 (09) 1242-1245
    CrossrefPubMedGoogle Scholar
  • 11 Vrijland WW, Jeekel J, van Geldorp HJ, Swank DJ, Bonjer HJ. Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 2003; 17 (07) 1017-1022
    CrossrefPubMedGoogle Scholar
  • 12 Operative Laparoscopy Study Group. Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertil Steril 1991; 55 (04) 700-704
    CrossrefPubMedGoogle Scholar
  • 13 Barkan H, Webster S, Ozeran S. Factors predicting the recurrence of adhesive small-bowel obstruction. Am J Surg 1995; 170 (04) 361-365
    CrossrefPubMedGoogle Scholar
  • 14 ten Broek RP, van den Beukel BA, van Goor H. Comparison of operative notes with real-time observation of adhesiolysis-related complications during surgery. Br J Surg 2013; 100 (03) 426-432
    CrossrefPubMedGoogle Scholar
  • 15 ten Broek RP, Strik C, Issa Y, Bleichrodt RP, van Goor H. Adhesiolysis-related morbidity in abdominal surgery. Ann Surg 2013; 258 (01) 98-106
    CrossrefPubMedGoogle Scholar
  • 16 Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 2000; 87 (04) 467-471
    CrossrefPubMedGoogle Scholar
  • 17 Sikirica V, Bapat B, Candrilli SD, Davis KL, Wilson M, Johns A. The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg 2011; 11 (13) 1-9
    CrossrefPubMedGoogle Scholar
  • 18 Tingstedt B, Isaksson J, Andersson R. Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg 2007; 94 (06) 743-748
    CrossrefPubMedGoogle Scholar
  • 19 Korell M. Methods of adhesion prophylaxis - pros and cons. J Gynäkol Endokrinol 2010; 20 (02) 6-13
    PubMedGoogle Scholar
  • 20 Crowe A, Trew G. State-of-the-art in adhesion prevention. In: De Wilde RL, Schmidt EH. , eds. State-of-the-Art Prevention of Adhesions in Gynecology. Bremen: UNI-MED Verlag AG; 2010: 20-36
    Google Scholar
  • 21 Felton RJ, Tuggle DW, Milewicz AL. , et al. High mortality with an intraperitoneal antiadhesive in the rat. Curr Surg 1990; 47 (06) 444-446
    PubMedGoogle Scholar
  • 22 Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG. ; Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 2003; 46 (10) 1310-1319
    CrossrefPubMedGoogle Scholar
  • 23 Korell M. Combined hemostasis and adhesion prevention with the novel agent 4DryField PH—initial observations. Surg Sci 2014; 5 (12) 533-539
    CrossrefPubMedGoogle Scholar
  • 24 Ziegler N, Korell M, Herrmann A. , et al. Uterine perforation following a fractional curettage successfully treated with the modified polysaccharide 4DryField® PH: a case report. J Med Case Reports 2016; 10 (01) 243
    CrossrefPubMedGoogle Scholar
  • 25 Sieg L, Eismann H, Schumacher C, Floricke F, Johanning K, Hanke AA. Effects of microporous polysaccharide powder in a model of dilution on viscoelastic characteristics of clot formation - an in-vitro study. ARC J of Anesthesiol 2017; 2 (04) 10-17
    PubMedGoogle Scholar
  • 26 Korell M, Ziegler N, De Wilde RL. Use of modified polysaccharide 4DryField PH for adhesion prevention and hemostasis in gynecological surgery: a two-center observational study by second-look laparoscopy. BioMed Res Int 2016; 2016: 3029264
    PubMedGoogle Scholar
  • 27 Poehnert D, Abbas M, Kreipe H-H, Klempnauer J, Winny M. Evaluation of 4DryField® PH as adhesion prevention barrier tested in an optimized adhesion model in rats. Eur Surg Res 2015; 55 (04) 341-351
    CrossrefPubMedGoogle Scholar
  • 28 Poehnert D, Grethe L, Maegel L. , et al. Evaluation of the effectiveness of peritoneal adhesion prevention devices in a rat model. Int J Med Sci 2016; 13 (07) 524-532
    CrossrefPubMedGoogle Scholar
  • 29 Pujahari AK. Decision making in bowel obstruction: a review. J Clin Diagn Res 2016; 10 (11) PE07-PE12
    PubMedGoogle Scholar
  • 30 Han ES, Scheib SA, Patzkowsky KE, Simpson K, Wang KC. The sticky business of adhesion prevention in minimally invasive gynecologic surgery. Curr Opin Obstet Gynecol 2017; 29 (04) 266-275
    CrossrefPubMedGoogle Scholar
  • 31 Blumhardt G, Haas M, Polte S. Effect of 4DryField PH, a novel adhesion barrier, on recurrence of intestinal adhesions after extensive visceral adhesiolysis. Case Rep Surg 2018; 2018: 9628742
    PubMedGoogle Scholar
  • 32 Coccolini F, Ansaloni L, Manfredi R. , et al. Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg 2013; 8 (01) 6
    CrossrefPubMedGoogle Scholar
  • 33 The American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49 (06) 944-955
    CrossrefPubMedGoogle Scholar
  • 34 Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, diZerega GS. ; Adept Adhesion Reduction Study Group. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril 2007; 88 (05) 1413-1426
    CrossrefPubMedGoogle Scholar
  • 35 Trew G, Pistofidis G, Pados G. , et al. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011; 26 (08) 2015-2027
    CrossrefPubMedGoogle Scholar
  • 36 Scott-Coombes DM, Vipond MN, Thompson JN. General surgeons' attitudes to the treatment and prevention of abdominal adhesions. Ann R Coll Surg Engl 1993; 75 (02) 123-128
    PubMedGoogle Scholar
  • 37 Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update 2001; 7 (06) 567-576
    CrossrefPubMedGoogle Scholar
  • 38 diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 2001; 7 (06) 547-555
    CrossrefPubMedGoogle Scholar
  • 39 Mäkinen J, Johansson J, Tomás C. , et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001; 16 (07) 1473-1478
    CrossrefPubMedGoogle Scholar
  • 40 Mäkinen J, Brummer T, Jalkanen J. , et al. Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study. BMJ Open 2013; 3 (10) e003169
    CrossrefPubMedGoogle Scholar
  • 41 Tchartchian G, Hackethal A, Herrmann A. , et al. Evaluation of SprayShield™ Adhesion Barrier in a single center: randomized controlled study in 15 women undergoing reconstructive surgery after laparoscopic myomectomy. Arch Gynecol Obstet 2014; 290 (04) 697-704
    CrossrefPubMedGoogle Scholar
  • 42 Kavic SM, Kavic SM. Adhesions and adhesiolysis: the role of laparoscopy. JSLS 2002; 6 (02) 99-109
    PubMedGoogle Scholar
  • 43 Hirschelmann A, Tchartchian G, Wallwiener M, Hackethal A, De Wilde RL. A review of the problematic adhesion prophylaxis in gynaecological surgery. Arch Gynecol Obstet 2012; 285 (04) 1089-1097
    CrossrefPubMedGoogle Scholar
  • 44 Ahmad G, O'Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 2015; 4 (04) CD000475
    PubMedGoogle Scholar
  • 45 PlantTec Medical GmbH. 4DryField PH—provides hemostasis—prevents adhesions: instructions for use, rev. 6.0, 30.03.2015. Bad Bevensen:1–76
    PubMed
  • 46 Nakamura T, Sato T, Naito M. , et al. Laparoscopic surgery is useful for preventing recurrence of small bowel obstruction after surgery for postoperative small bowel obstruction. Surg Laparosc Endosc Percutan Tech 2016; 26 (01) e1-e4
    PubMedGoogle Scholar
  • 47 Landercasper J, Cogbill TH, Merry WH, Stolee RT, Strutt PJ. Long-term outcome after hospitalization for small-bowel obstruction. Arch Surg 1993; 128 (07) 765-770 , discussion 770–771
    PubMedGoogle Scholar
  • 48 Ellis H, Harrison W, Hugh TB. The healing of peritoneum under normal and pathological conditions. Br J Surg 1965; 52: 471-476
    CrossrefPubMedGoogle Scholar
  • 49 Hellebrekers BWJ, Kooistra T. Pathogenesis of postoperative adhesion formation. Br J Surg 2011; 98 (11) 1503-1516
    CrossrefPubMedGoogle Scholar
  • 50 Karsch J-J, Berthold M, Breul J. Evaluation of lymphorrhea and incidence of lymphoceles: 4DryField PH in radical retropubic prostatectomy. Adv Urol 2016; 2016: 2367432
    PubMedGoogle Scholar
  • 51 Poehnert D, Abbas M, Maegel L. , et al. Evaluation of the biological tolerability of the starch-based medical device 4DryField® PH in vitro and in vivo a rat model. J Biomater Appl 2015; 30 (04) 463-471
    CrossrefPubMedGoogle Scholar