A randomized controlled trial of 0.5% ferric hyaluronate gel (Intergel) in the prevention of adhesions following abdominal surgery.

摘要: Peritoneal adhesion is an inevitable consequence of abdominal surgery and a cause significant postoperative morbidity. They predispose to recurrent episodes pain intestinal obstruction that frequently require hospitalization.1,2 This adds the financial burden placed on healthcare system adversely affects quality life.3,4 Much interest has been focused reducing incidence adhesions. Simple approaches include use unpowdered gloves, generous irrigation peritoneum with distilled water or normal saline after surgery, addition anti-inflammatory agents into wash. Such measures have not very effective.5 A number therapeutic shown potential promise, including antiadhesive membranes (INTERCEED Absorbable Adhesion Barrier, Ethicon, Somerville, NJ; Preclude Surgical Membrane, W.L. Gore Co.; Seprafilm Genzyme, Cambridge, MA) may be laid localized areas peritoneum; viscous gels (Hyskon, Pharmacia, Piscataway, Sepracoat, Genzyme) instilled peritoneal cavity. Although gel formulations theoretical advantage formation throughout cavity, some preparations associated undesirable side effects because their oncotic nature resulting in ascites.6 In addition, gravitational pooling limit effectiveness following certain types surgery.5 A new preparation, Intergel (Lifecore Biomedical Inc., Chaska, MN), introduced uses formulation naturally occurring polysaccharide, hyaluronic acid (HA). Cross-linkage carboxylate groups HA molecules by chelation ferric (Fe3+) ions results lubricating preparation. Instillation cavity minimizes tissue apposition during critical period fibrin mesothelial regeneration. Lymphatic drainage appears major route elimination from estimated half-life 51 hours.7 HA-based reduce numerous animal studies.8–13 humans, randomized controlled trial involving promising pelvic gynecologic achieving 59% reduction formation.14 A was started at our institution evaluate role as agent open surgery. The suspended recruitment 32 patients occurrence adverse events treatment arm.