Surgical Adhesions and Barriers

• Surgical barriers: are they effective in preventing adhesion pain?

Surgeons have a number of products at their disposal to reduce the risk of adhesions, including synthetic barrier agents. It is your responsibility to inform patients of the potential benefits and risks of using these products before a procedure is performed.

Synthetic barrier products can reduce the risk of adhesion by replicating the natural membranes that cover your vital organs. When the delicate surfaces of your organs come into contact with each other during surgery, especially abdominal and pelvic surgeries, the tissues can stick together.

Surgical trauma often leads to the formation of scar tissue, which can eventually cause the intestines to twist, pull, twist, or block. A partial intestinal blockage can resolve under close medical supervision. A complete blockage is a medical emergency, often requiring immediate surgery. Adhesions after abdominal or pelvic surgery can also cause infertility in women. Severe abdominal pain, nausea, loud bowel sounds, and bloating are common symptoms of adhesions.

• How Surgical Barriers Work

In combination with a safe surgical technique, surgical barriers can reduce the risk of scar formation and adhesion pain. During abdominal or pelvic surgery, synthetic barrier sheets made of regenerated cellulose, polytetrafluoroethylene, or fibrin can be applied to abdominal or pelvic tissues to keep organ surfaces separate. While some commonly used products, such as Gore-Tex, must be stitched in place and removed during a separate procedure, Interceed and Seprafilm, both Johnson & Johnson products, are absorbed into the body after surgery. Note * Insurance companies often do not compensate for the use of barrier products, transferring financial responsibility to the patient.

A 2008 review published in the Cochrane Database of Systematic Reviews compared the results of 16 clinical trials to evaluate the effectiveness of four barrier products in preventing adhesions in women undergoing pelvic surgery. The reviewers evaluated the results of the use of Gore-Tex, Interceed, Seprafilm and Fibrin. In most trials, Gore-Tex was more effective than Interceed or no barrier in preventing adhesions after surgery. Other clinical studies have shown that Interceed and Seprafilm can reduce the risk of pelvic and abdominal adhesions if used correctly.

The SprayShield adhesion barrier system, currently available only in Europe, protects internal tissues by applying a hydrogel spray. The hydrogel barrier, which turns blue with application so surgeons can visualize covered areas, keeps organ surfaces separate during and after surgery, while tissues heal. After the necessary healing time, the material is absorbed by the body and excreted by the kidneys in the urine. Although the SprayShield barrier system has performed well in preclinical studies in the United States and has been available to patients in Europe since 2008, the product has not yet been approved by the Food and Drug Administration for use in the United States.

• Risks of using surgical barriers

Like sutures, gauze, sponges, or any other material used during a surgical procedure, barrier agents can cause inflammation and adhesions if used incorrectly. If a barrier is padded, folded or applied in layers, the material can induce adhesions. Barriers should not be applied to tissues that are infected or areas that have been contaminated. Because each body reacts differently to foreign materials, reactions to these synthetic membranes can occur. Removing a nonabsorbable barrier after surgery can pose a risk of more adhesions forming.

• Who is responsible for preventing adhesion pain?

Synthetic barrier agents are not foolproof measures to prevent adhesions, but when used correctly, these products can reduce the risk of an often agonizing and life-threatening condition known as adhesion-related disorder (ARD). Medical professionals They are responsible for using these products consistently, educating patients on how adhesions form, and informing patients of the risk of adhesions prior to surgery.

On their product websites, Ethicon, the Johnson & Johnson company that makes the absorbable barrier Interceed, and Seprafilm advise patients to ask their surgeon before surgery about the risk of adhesion formation and the signs and symptoms of adhesions after surgery. Actually, how many patients are likely to visit these websites before surgery? Is it realistic to expect patients to conduct research on barrier agents or other highly specialized surgical products?

In fact, the responsibility for raising the risk of adhesions, and for considering ARD as a reasonable explanation for postoperative adhesion pain, rests with surgeons and other healthcare professionals, not with patients. It is your duty, and part of your ethical commitment, to promote adherence risk awareness and listen carefully to the concerns of your patients before and after surgery.

Sources

The Cochrane Library: Intervention Review: Barrier Agents for Adherence Prevention After Gynecologic Surgery; Gaity Ahmad et al .; April 16, 2008. “Journal of Reproductive Medicine”: Prevention of postoperative adhesion with a regenerated oxidized cellulose adhesion barrier in infertile women. T. Sawada, et al .; May 2000.

Pelvic Health Solutions: Overview: Gynecare Interceed.

Reuters.com: Covidien introduces the SprayShield ™ adhesion barrier system to the European market.