Reproductive Surgery Adhesion Prevention
RRM Academy Synopsis
Interceed barrier reduced pelvic adhesions after infertility surgery
Sidewalls covered with the Interceed barrier formed adhesions less often than bare sidewalls. In a 1989 trial paid for by its maker, 74 women had surgery for infertility. One pelvic sidewall was covered. At the second look, about 5 out of 10 covered sides had adhesions, against about 7 out of 10 bare sides.
Key Findings
- At second-look laparoscopy, 34 of 74 (46%) Interceed-covered sidewalls had adhesions, against 53 of 74 (72%) control sidewalls (P = 0.003, chi-square).
- Among women with adhesions on one sidewall only, 26 had them on the control side and 7 on the Interceed side (McNemar test).
- The authors report a 90% improvement over surgery alone in preventing adhesions, based on 40 covered and 21 control sidewalls with no adhesions.
- The authors report a 57% improvement over surgery alone in reducing the extent of adhesions, a figure they calculated from area measurements.
- Severe adhesions were less common on covered sidewalls (P = 0.028, chi-square). Sidewall-ovary adhesions appeared in 25 women on the control side only, against 5 on the covered side only.
Interpretation
A sealed envelope picked one pelvic sidewall to cover with the Interceed barrier in each woman. The other sidewall stayed bare, so each woman served as her own control. Nine centers enrolled 74 women from July 1986 to April 1988. A second surgery to look for adhesions took place 10 days to 14 weeks later. The covered sidewalls had fewer and milder adhesions than the bare sidewalls on every measure the authors reported. Larger studies of barrier use in pelvic surgery for infertility would build on these findings.
RRM Context
Restorative reproductive medicine looks for root causes of infertility. Surgery can leave adhesions behind. Adhesions can make it harder to get pregnant. This 1989 paper gives evidence for one barrier product used to cut down on adhesions during pelvic surgery.
Abstract
INTERCEED(TC7) (Johnson & Johnson Patient Care Inc., New Brunswick, NJ) is an absorbable fabric specially designed to reduce postsurgical adhesions. The authors report on a prospective, randomized, multicenter, clinical trial that evaluated the efficacy of Interceed in reducing adhesions in humans. Infertility patients (n = 74) with bilateral pelvic sidewall adhesions were studied at treatment laparotomy and "second-look" laparoscopy to determine Interceed's effectiveness. After removal of adhesions at laparotomy, the deperitonealized area of one pelvic sidewall was covered with Interceed. The contralateral untreated sidewall served as the control. Pelvic sidewalls covered with Interceed had a 90% improvement over control sidewalls in preventing adhesion formation. Additionally, Interceed treatment was associated with a 57% reduction of the extent of adhesion formation over that obtained by microsurgical techniques alone. Interceed also provided a significant benefit in reducing the severity of those adhesions that did form, and significantly reduced the number of adhesions between the ovary and pelvic sidewall. In conclusion, Interceed significantly reduced the incidence, extent, and severity of postsurgical pelvic adhesions.
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Topics
Keywords
Cellulose/analogs & Derivatives, Cellulose, Oxidized/adverse Effects/therapeutic Use, Clinical Trials As Topic, Female, Humans, Infertility, Female, Laparoscopy/adverse Effects, Laparotomy/adverse Effects, Multicenter Studies As Topic, Postoperative Complications/prevention & Control, Prospective Studies, Random Allocation, Tissue Adhesions/prevention & Control, Tissue Adhesives/adverse Effects/therapeutic Use, Cellulose, Oxidized, INTERCEED, Tissue Adhesives, Cellulose
