title: Efficacy of Seprafilm for preventing adhesive bowel obstruction and cost-benefit analysis in pediatric patients undergoing laparotomy.
abstract: OBJECTIVE
  This aim of the study is to determine whether the use of Seprafilm reduces the incidence and the medical costs of adhesive bowel obstruction (ABO) in children.
  
  
  METHODS
  Pediatric patients undergoing laparotomy were prospectively assigned to the Seprafilm group, n = 441). A historical control group consisted of children without using Seprafilm (n = 409). The incidence of ABO during a 24-month follow-up period was compared between the groups. To clarify the cost-benefit relations, expenses for Seprafilm and medical costs for hospitalization related to ABO in the Seprafilm group were compared with the ABO-associated hospitalization costs in the control group.
  
  
  RESULTS
  The cumulative incidence rate of ABO in the control group was significantly higher than in the Seprafilm group (4.9% vs. 2.0%, p = 0.015). Nearly all cases that required adhesiolysis had adhesions to areas other than the incision in both groups. In cost-benefit analysis, cost per patient was $105 higher in the control group than in the Seprafilm group, but this did not reach significance (p = 0.63).
  
  
  CONCLUSIONS
  Seprafilm reduces the incidence of ABO in the pediatric patients undergoing laparotomy. Although associated medical costs in the Seprafilm group were not significantly reduced, use of Seprafilm did not lead to an increase in cost. Wider range of Seprafilm application or an additional anti-adhesion device may help in preventing adhesion to areas other than the incision.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Inoue
authors.forename: Keiichi
authors.initials: K
authors.lastname: Uchida
authors.forename: Kohei
authors.initials: K
authors.lastname: Otake
authors.forename: Yuka
authors.initials: Y
authors.lastname: Nagano
authors.forename: Shozo
authors.initials: S
authors.lastname: Ide
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Kohei
authors.initials: K
authors.lastname: Matsushita
authors.forename: Yuhki
authors.initials: Y
authors.lastname: Koike
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mohri
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000191:economics* / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000453:epidemiology / Q000517:prevention & control; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000517:prevention & control*; D007813:Laparotomy / Q000191:economics* / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000453:epidemiology / Q000517:prevention & control
chemical_list: C118198:Seprafilm; D006820:Hyaluronic Acid
keywords: Adhesive intestinal obstruction; Children; Medical cost; Seprafilm