Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure?

被引：50

作者：

Salum M. ^{[1
]}

Wexner S.D. ^{[1
]}

Nogueras J.J. ^{[1
]}

Weiss E. ^{[1
]}

Koruda M. ^{[2
]}

Behrens K. ^{[2
]}

Cohen S. ^{[3
]}

Binderow S. ^{[3
]}

Cohen J. ^{[3
]}

Thorson A. ^{[4
]}

Ternent C. ^{[4
]}

Christenson M. ^{[4
]}

Blatchford G. ^{[4
]}

Pricolo V. ^{[5
]}

Whitehead M. ^{[6
]}

Doveney K. ^{[6
]}

Reilly J. ^{[7
]}

Glennon E. ^{[7
]}

Larach S. ^{[8
]}

Williamson P. ^{[8
]}

Gallagher J. ^{[8
]}

Ferrara A. ^{[8
]}

Harford F. ^{[9
]}

Fry R. ^{[10
]}

Eisenstat T. ^{[11
]}

Notaro J. ^{[11
]}

Chinn B. ^{[11
]}

Yee L. ^{[12
]}

Stamos M. ^{[13
]}

Cole P. ^{[14
]}

Dunn G. ^{[14
]}

Singh A. ^{[15
]}

机构：

[1] Cleveland Clinic Florida, Weston, FL 33331

[2] University of North Carolina, Chapel Hill, NC

[3] Atlanta Colon and Rectal Surgery Department, Atlanta, GA

[4] Colon and Rectal Surgery, Omaha, NE

[5] University Surgical Associates, Providence, RI

[6] Oregon Health Sciences University, Portland, OR

[7] Colon and Rectal Surgery Department, Erie, PA

[8] Colon and Rectal Clinic, Orlando, FL

[9] Loyola University of Chicago, Maywood, IL

[10] Thomas Jefferson University, Philadelphia, PA

[11] Associates of Colon and Rectal Surgeons, Edison, NJ

[12] California Pacific Medical Center, San Francisco, CA

[13] Harbor UCLA Medical Center, Torrence, CA

[14] Colon and Rectal Associates, Shereport, LA

[15] State University of New York, Buffalo, NY

来源：

Techniques in Coloproctology | 2006年 / 10卷 / 3期

关键词：

Adhesions; Bioresorbable membrane; Carboxymethylcellulose; Complications; Loop ileostomy; Sodium hyaluronate;

D O I：

10.1007/s10151-006-0278-x

中图分类号：

学科分类号：

摘要：

Background: Adhesions can result in serious clinical complications and make ileostomy closure, which is relatively simple procedure into a complicated and prolonged one. The use of sodium hyaluronate and carboxymethyl cellulose membrane (Seprafilm®) was proven to significantly reduce the postoperative adhesions at the site of application. The aim of this study was to assess the incidence and severity of adhesions around a loop ileostomy and to analyze the lenght of time and morbidity for mobilization at the time of ileostomy closure with and without the use of Seprafilm. Methods: Twenty-nine surgeons from 15 institutions participated in this multicenter prospective randomized study. 191 patients with loop ileostomy construction were randomly assigned to either receive Seprafilm under the midline incision and around the stoma (Group I), only under the midline incision (Group II), or not to receive Seprafilm (Group III). At ileostomy closure, adhesions were quantified and graded; operative morbidity was also measured. Results: All 3 groups were comparable relative to gender, mean age and number of patients with prior operations (26, 25 and 19, respectively). Group II patients were significantly more likely to have pre-existing adhesions than Group III patients (30.6% vs. 14.1%, p=0.025). At stoma mobilization, significantly more patients in Group III than in Group I had adhesions around the stoma (95.2% vs. 82.3%, p=0.021). Mean operative times were 27, 25, and 28 minutes, respectively (p=0.38), with significant differences among sites. There was no significant difference in the number of patients needing myotomy or enterotomy (29, 27 and 24 patients, respectively), nor in the number of postoperative complications (7, 9 and 7 patients, respectively). Conclusions: When consistently applied, Seprafilm significantly decreased adhesion formation around the stoma but not operative times without any increase in the need for myotomy or enterotomy. These findings were not seen in the overall study population possibly due to the large number of surgeons using a variety of application techniques.

引用

页码：187 / 190

页数：3

共 16 条

[1] Scott-Coombes D.M., Vipond M.N., Thompson T.N., General surgeons' attitudes to the treatment and prevention of abdominal adhesions, Ann R Coll Surg Engl, 75, pp. 123-128, (1993)
[2] Ellis H., The clinical significance of adhesions: Focus on intestinal obstruction, Eur J Surg Suppl, 557, pp. 5-9, (1997)
[3] Menzies D., Ellis H., Intestinal obstruction from adhesions: How big is the problem?, Ann R Coll Surg, 72, pp. 60-63, (1990)
[4] Monk B.J., Berman M.L., Montz F.J., Adhesions after extensive gynecologic surgery: Clinical significance, etiology and prevention, Am J Obstet Gynecol, 170, pp. 1396-1403, (1994)
[5] Ray N.F., Larsen Jr. J.W., Stillman R.J., Jacobs R.J., Economic impact of hospitalization for lower abdominal adhesiolysis in US in 1988, Surg Gynecol Obstet, 176, pp. 271-276, (1993)
[6] Beck D.E., Ferguson M.A., Opelka F.G., Et al., Effect of previous surgery on abdominal opening time, Dis Colon Rectum, 43, pp. 1749-1753, (2000)
[7] Coleman M.G., McLain A.D., Moran B.J., Impact of previous surgery on time taken for incision and division of adhesions during laparotomy, Dis Colon Rectum, 43, pp. 1297-1299, (2000)
[8] Van Der Krabben A.A., Dijkstra F.R., Nieuwenhuijzen M., Et al., Morbidity and mortality of inadvertent enterotomy during adhesiotomy, Br J Surg, 87, pp. 467-471, (2000)
[9] Becker J.M., Dayton M.T., Fazio V.W., Et al., Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: A prospective, randomized, double-blind multicenter study, J Am Coll Surg, 183, pp. 297-306, (1996)
[10] Salum M.R., Lam D.T.Y., Wexner S.D., Et al., Does limited placement of bioresorbable membrane of modified sodium hyaluronate and carboxymethylcellulose (Seprafilm) have possible short-term beneficial impact?, Dis Colon Rectum, 44, pp. 706-712, (2001)

← 1 2 →