Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7+) in preventing adhesions

A. F. Haney; John Hesla; Bradley S. Hurst; L. Michael Kettel; Anna A. Murphy; John A. Rock; Guillermo Rowe; William D. Schlaff

doi:10.1016/s0015-0282(16)57541-4

Reproductive Surgery Adhesion Prevention

Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7+) in preventing adhesions

Haney AF, Hesla J, Hurst BS, Kettel LM, Murphy AA, Rock JA, Rowe G, Schlaff WD

Published May 1995 Fertility and Sterility, 63(5), 1021-1026

DOI 10.1016/s0015-0282(16)57541-4 PMID 7720911

RRM Academy Synopsis

Gore-Tex barrier left fewer adhesions than Interceed in 32 women

Gore-Tex sidewalls ended with lower adhesion scores than Interceed sidewalls. In this randomized trial, 32 women with sidewall adhesions got one barrier per side. About 7 out of 10 Gore-Tex sides had no adhesions at second look, against about 2 out of 10 Interceed sides (29 sides each).

Key Findings

Adhesion score at second look (0 to 11 scale, mean ± SEM) was 0.97 ± 0.30 with PTFE (Gore-Tex) and 4.76 ± 0.61 with oxidized regenerated cellulose (Interceed), P ≤ 0.0001.
Area of adhesion was 0.95 ± 0.35 cm2 with PTFE and 3.25 ± 0.62 cm2 with oxidized regenerated cellulose (P ≤ 0.0001).
Sidewalls with no adhesions at second look: 21 of 29 (72.4%) with PTFE and 7 of 29 (24%) with oxidized regenerated cellulose.
Among patients with adhesions on one side, 16 sidewalls covered with PTFE were adhesion-free, against 2 covered with oxidized regenerated cellulose.
Adhesion area improved by 86.0% ± 0.06% with PTFE and 47.4% ± 0.11% with oxidized regenerated cellulose (P ≤ 0.0001).

Interpretation

This randomized trial gave each woman both barriers, one per sidewall, chosen by random draw. Thirty-two women enrolled. 29 had a second-look surgery about 30 days later. Gore-Tex sidewalls came out ahead on every adhesion measure. The authors note that removing the PTFE barrier required its own extra surgery, which carries its own adhesion risk. The findings support larger studies comparing these two barrier materials.

RRM Context

NaProTechnology surgery uses excision and works to prevent adhesions. Barrier choice matters to that goal. Some surgeries in this trial may have treated endometriosis.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To compare the impact of expanded polytetrafluoroethylene (PTFE; Gore-Tex Surgical Membrane; W. L. Gore & Associates, Inc., Flagstaff, AZ) and oxidized regenerated cellulose (Interceed TC7, Johnson & Johnson Medical, Inc., Arlington, TX) on the development of postsurgical adhesions.

Design

A multicenter, nonblinded, randomized clinical trial.

Setting

University medical centers.

Interventions

Each barrier was allocated randomly to the left or right sidewall of every patient.

Patients

Thirty-two women with bilateral pelvic sidewall adhesions undergoing reconstructive surgery and second-look laparoscopy.

Main Outcome Measures

Adhesion score (on a 0- to 11-point scale), the area of adhesion (cm2), and the likelihood of no adhesions.

Results

The use of both barriers was associated with a lower adhesion score and area of adhesion postoperatively. However, those sidewalls covered with PTFE had a significantly lower adhesion score (0.97 +/- 0.30 versus 4.76 +/- 0.61 points, mean +/- SEM) and area of adhesion (0.95 +/- 0.35 versus 3.25 +/- 0.62 cm2). Overall, more sidewalls covered with PTFE had no adhesions (21 versus 7) and, when adhesions were present on the contralateral sidewall, the number of sidewalls covered with PTFE without adhesions was greater than those covered with oxidized regenerated cellulose (16 versus 2).

Conclusion

Expanded polytetrafluoroethylene was associated with fewer postsurgical adhesions to the pelvic sidewall than oxidized regenerated cellulose.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

Reproductive Surgery Adhesion Prevention Barrier Agents

Reproductive Surgery › Adhesion Prevention › Barrier Agents

John Hesla, Bradley S. Hurst, L. Michael Kettel, Anna A. Murphy, John A. Rock, Guillermo Rowe, William D. Schlaff

Jack Hesla, J Hesla, B Hurst, A Murphy, Jack Rock, J Rock, G Rowe, Bill Schlaff, Will Schlaff, Billy Schlaff, W Schlaff

PMID 7720911 7720911 DOI 10.1016/s0015-0282(16)57541-4 10.1016/s0015-0282(16)57541-4 Haney et al. 1995, Haney 1995

Keywords

Adolescent, Adult, Cellulose/therapeutic Use, Female, Humans, Laparoscopy, Oxidation-Reduction, Polytetrafluoroethylene/therapeutic Use, Reoperation, Tissue Adhesions/prevention & Control, Polytetrafluoroethylene, Cellulose

Expanded polytetrafluoroethylene (Gore-Tex Surgical Membrane) is superior to oxidized regenerated cellulose (Interceed TC7+) in preventing adhesions

Gore-Tex barrier left fewer adhesions than Interceed in 32 women

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

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Keywords