Hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm) reduces adhesion under the incision to make unplanned re-laparotomy safer

Hyaluronate carboxymethylcellulose-based bioresorbable membrane (HC membrane; Seprafilm(A (R))) is used to prevent postoperative adhesion. We conducted this study to assess the effectiveness of the HC membrane in reducing the severity of adhesions in patients undergoing unplanned re-laparotomy. Between February, 2002 and December, 2010, 123 patients underwent abdominal surgery followed by a re-laparotomy in Kumamoto Regional Medical Center. The HC membrane was placed under the first abdominal incision in 60 patients (HC membrane group), whereas it was not used in the other 63 patients (control group). We compared the medical and operative records of these two groups. At the second laparotomy, adhesion under the incision was severe in many of the control group patients, but was significantly reduced in the HC membrane group. Postoperative small-bowel obstruction was significantly less frequent in the HC membrane group. According to univariate analysis of the risk factors for adhesion, prolonged operation time, blood loss, and not using an HC membrane were significantly associated with severe adhesion. Multivariate analysis revealed that only not using the HC membrane was significant. The HC membrane effectively reduces the severity of wound adhesion, making unplanned repeated laparotomy safer.