Efficacy of an antiadhesive agent for the prevention of intra-abdominal adhesions after radical gastrectomy

Abstract

Background: Guardix-SG is a poloxamer-based antiadhesive agent. The aim of this study was to investigate its efficacy in preventing abdominal adhesions in gastric cancer patients undergoing gastrectomy. Few clinical studies have reported that antiadhesive agent reduces the incidence of adhesion after gastrectomy. Methods: We conducted a multicenter trial from June 2013 and August 2015 in patients with gastric adenocarcinoma undergoing radical gastrectomy. Patients were randomly assigned to the Guardix treatment or control group. Postoperative adhesions were diagnosed based on postoperative symptoms, plain x-ray films, and computed tomography. The primary endpoint of the study was the incidence of small bowel obstruction in the first postoperative year. The secondary end-point was the safety of Guardix-SG. Results: The study included 109 patients in the Guardix group and 105 patients in the control group. The groups were similarly matched with pathological stage, operation type, anastomosis method, midline incision length, and the extent of lymph node dissection. Eight in the Guardix group and 21 in the control group experienced intestinal obstruction during the 1-year follow-up period. The cumulative incidence of small bowel obstruction was significantly lower in the Guardix group compared to that seen in the control group (4.7% vs 8.6% at 6 months and 7.3% vs 20% at 1 year; P = .007, log-rank test). There were no differences in postoperative complications and adverse events. Conclusion: Guardix-SG significantly decreased the incidence of intestinal obstruction without affecting the incidence of postoperative complications.

A Randomized Controlled Trial of Thermo-Sensitive Sol–Gel Anti-Adhesion Agent after Gynecologic Surgery

“…Mediclore has been previously demonstrated to be safe and effective in the prevention of adhesion formation after various surgical procedures [29][30][31]. A recent study reported that the use of another poloxamer-based thermo-sensitive anti-adhesion agent reduced the incidence of intestinal obstruction after radical gastrectomy for gastric cancer without increasing the risk of complications [35]. In line with the previous studies, we also demonstrated the adhesion-prevention effects and safety of Mediclore in patients who underwent benign gynecologic surgeries.…”

Barrier materials for prevention of surgical adhesions: systematic review

“…PEG has had positive outputs in terms of patient safety, cost-effectiveness, and level of postoperative pain 157 , 159 , 160 . Poloxamer 407 alginate has been shown to have a high level of patient safety 165 , but cost-effectiveness, and postoperative pain are unknown.…”

Cross‐linked cartilage acellular matrix film decreases postsurgical peritendinous adhesions

“…Natural polymer based antiadhesives utilize materials such as hyaluronic acid, chitosan, and carboxymethylcellulose . A number of products showed good clinical results in abdominal surgery . Most natural polymer based products, however, are biomechanically weak and degrade too quickly to be used during tendon surgery.…”

“…[28][29][30] A number of products showed good clinical results in abdominal surgery. [31][32][33] Most natural polymer based products, however, are biomechanically weak and degrade too quickly to be used during tendon surgery. Such limitations have led to research regarding decellularized tissue, which are both bioactive and biomechanically stronger than classic natural polymers.…”