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
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
Medical Sciences) and INTERGEL
(formerly LUBRICOAT) (LifeCore
Biomedical). These however may not be available
in the USA until at least the year 2000.
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.