International Adhesions Society





A Patient's Guide to Adhesions & Related Pain (part 7)

Adhesion Barriers

For over 100 years, surgeons have tried to use drugs and other materials to prevent adhesions (Wiseman, 1994) from occurring or recurring with little success.  Such materials have included animal membranes, gold foils, mineral oil, silk, rubber and Teflon sheets and even the amniotic membranes (membranes which surround an unborn baby).  These materials are placed at or near the site of surgery, rather like a wound dressing.  Other exotic treatments have included ingesting iron filings and then moving a magnet around on the abdomen to keep the bowel moving and prevent it from sticking.  When the tissue has healed, there is no longer a danger of forming adhesions.

Recently, scientists have been successful in developing effective absorbable adhesion barriers that protect tissue and dissolve when they are no longer needed.  To date, the only products specifically approved by Food and Drug Administration for use in humans are INTERCEED™ Barrier, made by Johnson & Johnson, and Seprafilm™ made by Genzyme Corporation.  INTERCEED™ Barrier has been shown to be efficacious in gynecological surgery and Seprafilm™ in certain types of gynecological and general surgery.  However, the use of INTERCEED™ and Seprafilm™ is still limited for a variety of reasons and they do not prevent adhesions every time.  Furthermore, neither product has been rigorously tested on patients with severe recurrent ADHESIONS such as the ones described in this article.

Another product, PRECLUDE™ made by WL Gore, is made of Gore-Tex, a version of Teflon™.  It is not specifically approved to reduce adhesions, although some doctors use it for this purpose.  It does not dissolve in the body and many doctors like to perform a subsequent surgery to remove it.  Today many surgeons still instill large volumes of crystalloid, or salt (saline) solutions into the abdomen in the belief that these alone will reduce adhesions.  This premise is not supported by clinical data.

Other products are currently undergoing clinical testing such as ADCON™ P (Gliatech), REPEL™ and RESOLVE™ (Life Medical Sciences) and INTERGEL™ (formerly LUBRICOAT) (LifeCore Biomedical). These however may not be available in the USA until at least the year 2000.

Sepracoat, made by Genzyme, is only available in Europe because limited effectiveness was seen in US clinical studies.

It is important to note that whatever product is used, it must be combined with good surgical technique in which the surgeon handles tissues as delicately as possible, attempting to avoid further damage to them.  Powder-free gloves should be used whenever possible because of the association of talc (no longer used), and even starch used to lubricate the gloves, with adhesions.

It is unlikely that any one product will completely prevent ADHESIONS in all situations.  There thus remains a need for an improved product that works in a variety of surgical situations and works in a greater number of patients.

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