Table 4 Overview of most common applied adhesion barriers and their impact on adhesion formation and incidence of ASBO
Barrier | Marketed as | Comments |
|---|---|---|
Hyaluronate carboxymethylcellulose | Seprafilm® | Solid barrier most suitable for open surgery although laparoscopic placement has been described Studies in both general surgery and gynecological procedures Reduces adhesion formation, as well as the risk for reoperations for adhesive small bowel obstruction (relative risk 0.49, 95% CI 0.28–0.88) |
Oxidized regenerated cellulose | Interceed® | Solid barrier most suitable for open surgery Only studied in gynecological procedures Reduces incidence of adhesion formation relative risk 0.51, 95% CI 0.31–0.86 No studies available on subsequent risk of ASBO This workgroup does not recommend the use of this barrier to prevent ASBO in general surgery |
Icodextrin | Adept® | Liquid barrier, easy to apply in both open and laparoscopic surgery Good safety record in both general surgery and gynecological surgery Reduces recurrence of ASBO following surgery for ASBO in one trial (relative risk 0.20, 95% CI 0.04–0.88) |
Polyethylene glycol | Sprayshield®/Spraygel® | Gel barrier, easy to apply in both open and laparoscopic surgery Reduces adhesion score in both general surgery and gynecological trials Relative few and small studies, impact on long-term adhesion-related complications not described |