A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy.
OBJECTIVE
It is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm).


METHODS
The subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (n = 169), but it was used in all patients operated on from May 2003 onward (n = 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group.


RESULTS
The cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (P = 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (P = 0.049).


CONCLUSIONS
In this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.
Kawamura
Hideki
H
Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan.
Yokota
Ryoichi
R
Yokota
Kentaro
K
Watarai
Hiroshi
H
Tsunoda
Yoshihiko
Y
Yamagami
Hideki
H
Hata
Tsunetake
T
Tanaka
Koichi
K
Masuko
Hiroyuki
H
Ishizu
Hiroyuki
H
Okada
Kuniaki
K
Adachi
Takehiko
T
Kondo
Yukifumi
Y
D000368:Aged; D001672:Biocompatible Materials; D002266:Carboxymethylcellulose Sodium; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005763:Gastroenterostomy; D006801:Humans; D006820:Hyaluronic Acid; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control*; D007421:Intestine, Small; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*
D001672:Biocompatible Materials; D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium