Laparoscopic use of a hyaluronic acid carboxycellulose membrane slurry in gynecological oncology.
OBJECTIVE
We evaluated the use of a hyaluronic acid-carboxycellulose membrane (HAC) slurry in complex laparoscopies.


METHODS
A gel-like mixture of HAC was prepared and applied in 171 consecutive complex laparoscopies on a gynecologic oncology service. The HAC slurry was used to coat deperitonealized surfaces and surgical pedicals to prevent postoperative adhesions. The technique is described and the outcomes are prospectively evaluated for feasibility and safety.


RESULTS
There were no postoperative bowel obstructions, 1 pelvic hematoma in a patient on clopidogrel (Plavix) immediately prior to surgery, 8 postoperative ilea, and 1 bowel perforation. The bowel perforation occurred in a patient with extensive adhesiolysis and intraoperative bowel suturing.


CONCLUSIONS
This report describes an easy approach to the laparoscopic application of HAC. Caution should be taken if HAC slurry is applied after significant bowel suturing because 1 of 9 patients with extensive adhesiolysis requiring suturing of the sigmoid colon developed sigmoid perforations.
Lipetskaia
Lioudmila
L
Cancer Center Associates, St. Luke's Hospital, Bethlehem, Pennsylvania 18015, USA.
Silver
David F
DF
D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008567:Membranes, Artificial; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods
D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid