Safety of a new spray‐type adhesion barrier (AdSpray^®) in liver surgery

Abstract

Background Although adhesion barriers are increasingly used in liver surgery, there are no sufficient data yet in support of their safety. Methods Data of 104 consecutive patients in whom a spray‐type adhesion barrier (AdSpray®) was used after hepatectomy were compared with those of 94 control subjects in whom no adhesion barriers were used, and the risk factors for major morbidity after hepatectomy were investigated. Results The incidence of major morbidity was not significantly different between the AdSpray group and the control group (17% vs 15%, P = .645), although multivariate analyses revealed that the use of AdSpray was associated with an increased risk of abdominal abscess (odds ratio [OR], 4.42; P = .043). Similar tendency was also confirmed after propensity score adjustment to account for the potential selection bias. A sub‐group analysis revealed that incidence of abscess formation decreased as operators' experience in the used of AdSpray increased, and multivariate analysis identified preoperative chemotherapy (OR, 3.96; P = .043) as being independent predictors of abscess formation after the use of AdSpray. Conclusions AdSpray use was not associated with global incidence of major morbidity after liver surgery, although surgeon's experience would be needed for adequate use of AdSpray to minimize the risk of postoperative abscess formation.

Advancement of Biomaterial‐Based Postoperative Adhesion Barriers

“…When sprayed together, the N‐hydroxy succinimide modified carboxymethyl dextrin polymers link to form a hydrogel barrier within 10 s, a hydrogel predominantly of dextrin polymers and microbubbles consisting of 60 to 95% water with solids. [ 72 ] As we reported in ADEPT, dextrin can be degraded by amylase, too. A recent report about Adspray in clinical showed relative safety to Seprafilm in hepatectomy.…”

“…A recent report about Adspray in clinical showed relative safety to Seprafilm in hepatectomy. [ 72 ]…”

“…Various kinds of adhesion barriers are increasingly used in hepatobiliary surgery. [ 72,277–279 ] Optimal antiadhesive means for hepatectomy remains uncertain. Evaluating the efficacy of materials in clinical research is difficult because evaluating the severity of adhesions in repeat hepatectomy should overcome the observer's subjective bias and scoring reproducibility.…”

Oxidized Regenerated Cellulose Sheets in Postoperative Intrathoracic Adhesions

“…There are some reports about the use of adhesion barriers in abdominal surgery, and several types of adhesion barriers, including ORC sheets, are often used. [4][5][6] The ORC sheet is placed to cover the surgical site. It swells and eventually gels to form a barrier that protects it from adhesion, and it is slowly absorbed by hydrolysis within 28 days.…”

A new spray-type adhesion barrier (AdSpray) improves condition for surgical treatment in the reversal of Hartmann procedure

“…A new type of antiadhesion agent spray, AdSpray (Terumo, Tokyo, Japan), is reportedly useful in other three-dimensional fields such as the liver region. [ 5 ] However, there are no reports of its use in HP.…”