Adhesions are oftenthought of as internal scar tissue and are a side effect of the body’s natural healing process. For example,up to 93% of patients who undergo intra-abdominal surgery develop adhesions. The majority of adhesionsare asymptomatic; however, approximately 5% of adhesions result in severe symptoms such as pain, smallbowel obstruction (SBO), range of motion restriction and/or infertility. While only 5% of adhesions resultin symptoms severe enough to require further treatment, as many as 30% are thought to cause low leveldiscomfort that is tolerated by the patient. Adhesions are believed to be responsible for approximately% of all SBO, 35% of chronic pelvic pain and 20% of infertility diagnoses.
There are a number of different methods that surgeons use to reduce the incidence of adhesions. The mosteffective way is to perform laparoscopic procedures whenever possible, as they carry a much lower risk ofsymptomatic adhesion formation. In addition, surgeons attempt to minimize tissue necrosis, providingmeticulous hemostasis, liberally irrigating the abdominal cavity and using non-reactive suture materials.
In some situations, drugs that inhibit the inflammatory response, such as corticosteroids, non-steroidalanti-inflammatory, pentoxifylline and calcium channel blockers have been used. However, the mosteffective method of reducing adhesions has been determined to be the use of adhesion barriers.
The first of currently used products entered the market in 1989 and was made out of oxidized regeneratedcellulose (ORC). It is absorbed within four weeks of application. Seprafilm® by Genzyme consists ofsodium hyaluronate and carboxymethylcellulose, forming a film that becomes a hydrated gel 24 to 48hours after placement.