Reduction of postsurgical adhesions with intergel® adhesion prevention solution: a multicenter study of safety and efficacy after conservative gynecologic surgery

Johns, Douglas B.; Keyport, Georgiann M; Hoehler, Fred K.; diZerega, Gere S.

doi:10.1016/s0015-0282(01)01954-9

Cited by 113 publications

(68 citation statements)

References 24 publications

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“…Alternatively, the product may increase the incidence of anastomotic leakage or wound dehiscence such as with Intergel®. Adverse outcomes during clinical studies were considered serious enough to cause a product recall [124,128]. Other instances where an increased risk of anastomotic leakage has been observed are with the use of Seprafilm®.…”

Section: Methods Of Adhesion Reductionmentioning

confidence: 99%

Abdominal Adhesion Prevention: Still a Sticky Subject

et al. 2010

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Background: Adhesion formation remains an almost inevitable consequence of abdominal procedures, potentially resulting in significant morbidity and mortality. There is an ongoing need to evaluate current understanding of adhesion formation and products aimed at prevention. Failure to keep up to date with adhesion treatment may subject clinicians to a greater medico-legal risk. Design: Review of published studies exploring the problem of peritoneal adhesion formation. This encompasses the underlying processes of adhesion formation combined with general approaches to reduce formation. An overview of products trialled to prevent formation in both the animal model and clinical setting describes products of scientific interest and commercial success. Results: Advances in surgical technique, such as laparoscopic surgery, can help minimize the probability of adhesion formation. Currently barrier products, whilst reducing adhesion formation, have not been shown to reduce the risk of readmission with complications related to adhesions. Hybrid products may improve upon this situation. Conclusions: No single approach has been wholly satisfactory in reducing adhesions. Research into the processes driving adhesion formation is providing exciting new targets for therapeutic agents. It would seem plausible that with many promising avenues of research a revolutionary agent to reduce the incidence of adhesional small bowel obstruction may result.

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Section: Methods Of Adhesion Reductionmentioning

confidence: 99%

Abdominal Adhesion Prevention: Still a Sticky Subject

et al. 2010

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“…SEPRAFILM (Genzyme Corp. Cambridge, MA) 5,6 is somewhat brittle, is difficult to handle, and cannot be applied easily through a laparoscope. Both INTERGEL (Lifecore Biomedical, Chaska, MN) 7 (at the time of writing, this product has been withdrawn from the market, pending an assessment of possible side effects) and ADEPT (ML Laboratories Ltd., Leicester, UK) 8 are easy to apply but do not completely prevent adhesions. The search continues for agents that are easy to apply, function in the presence of bleeding, may be used on a variety of tissues, may be used to deliver drugs to a surgical site, completely prevent adhesions, do not reduce wound healing, do not potentiate infection, and do not evoke adhesions or fibrosis.…”

Section: Introductionmentioning

confidence: 99%

The effect of tranexamic acid in fibrin sealant on adhesion formation in the rat

Wiseman

Lyachovetsky²,

Keidan

et al. 2003

J Biomed Mater Res

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The objective of the research was to determine the effect of the type, dose, and volume of anti-fibrinolytic agents (tranexamic acid, aprotinin) added to fibrin formulations, on adhesion development. Adhesions were induced in 228 male rats by creating apposing parietal and visceral peritoneal defects. Animals were randomized to receive no treatment or a fibrin formulation containing aprotinin or tranexamic acid. Seven days later the incidence of adhesions, and the force and energy required to detach them, were determined. Adhesions developed in 13/13 rats in the control and aprotinin groups. Treatment with fibrin (100 mg/ml tranexamic acid) resulted in adhesions in 4/14 rats (as strips, p < or = 0.0005), 4/10 rats (as spray, p < or = 0.0036), and 12/15 rats (by drip). The reduction of adhesions was dependent on the concentration of tranexamic acid with strip and spray application. Using commercial formulations, tranexamic-acid-containing fibrin (10/15, p = 0.042), but not aprotinin-containing fibrin (13/15), reduced the incidence of side-wall adhesions from 15/15 in controls. Fibrin containing either tranexamic or aprotinin reduced the incidence and severity of adhesions. This effect was greater when tranexamic acid was used and was dependent on the mode of administration, the volume, and to a degree, the concentration of tranexamic acid.

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“…Hyaluronic acid In a large multicenter randomized trial, Intergel® (ferric hyaluronate, Ethicon-J&J, Somerville, NJ, USA) was effective in reducing the extension and severity of postoperative adhesions in comparison with Ringer's solution in patients undergoing peritoneal cavity surgery by laparotomy with a planned second-look laparoscopy [60]. But, due to unacceptable postoperative complications, the gel is no longer available [61].…”

Section: Gel Barriersmentioning

confidence: 99%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

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Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.

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Reduction of postsurgical adhesions with intergel® adhesion prevention solution: a multicenter study of safety and efficacy after conservative gynecologic surgery

Cited by 113 publications

References 24 publications

Abdominal Adhesion Prevention: Still a Sticky Subject

Abdominal Adhesion Prevention: Still a Sticky Subject

The effect of tranexamic acid in fibrin sealant on adhesion formation in the rat

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

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