Hyaluronic acid/ carboxymethyl cellulose-based adhesion barrier reduces surgical difficulty and complication in repeat hepatectomy

Adhesions as a risk factor for postoperative morbidity in patients undergoing repeat hepatectomy and the potential efficacy of adhesion barriers

“…Therefore, our group developed a novel measure to measure the degree of adhesion formation after liver surgery, ie, the TORAD (or, adhesion severity) score, and its performance in predicting the postoperative morbidity and interobserver agreement has been reported in our previous study 4 . Furthermore, preliminary studies conducted in small cohorts to determine the efficacy of use of adhesion barriers have validated the feasibility of assessment of the degree of formation of adhesions and confirmed a tendency towards a reduced extent of adhesion formation in patients who had received placement of adhesion barriers at the previous surgery 6,8 . We conducted this study to review the efficacy of use of adhesion barriers in a larger cohort and attempted to clarify the potential differences in efficacy among three commercially available adhesion barriers for liver surgery.…”

“…4 Furthermore, preliminary studies conducted in small cohorts to determine the efficacy of use of adhesion barriers have validated the feasibility of assessment of the degree of formation of adhesions and confirmed a tendency towards a reduced extent of adhesion formation in patients who had received placement of adhesion barriers at the previous surgery. 6,8 We conducted this study to review the efficacy of use of adhesion barriers in a larger cohort and attempted to clarify the potential differences in efficacy among three commercially available adhesion barriers for liver surgery.…”

“…One hundred twenty-two patients out of the 210 patients were derived from the cohort used in a previous preliminary report regarding the efficacy of Seprafilm. 9 Clavien-Dindo postoperative morbidities ≥grade IIIa were defined as major complications. All analyses were performed in accordance with the ethics guidelines for clinical studies in Japan, under the approval of the institutional review board of Toranomon Hospital (No.…”

“…The severity of adhesion formation was evaluated using the TORAD score, 4 as in previous studies. 6,8 Briefly, a three-grade scale based on the difficulty level in the lysis of adhesions (Easy, 1 point; Hard, 2 points; Extreme, 3 points) was applied to evaluate the severity of adhesion formation at the hepatic hilum (A score) and around the liver (B score), and the sum of these scores (ie, the TORAD score) was graded as follows: 2-3 points, Easy; 4 points, Hard; 5-6 points, Extreme.…”

“…Previous studies have reported that use of adhesion barriers was not associated with an increased risk of postoperative abdominal morbidity, [5][6][7] and a preliminary study conducted to investigate the efficacy of a conventional sheet-type adhesion barrier (Seprafilm ® ) reported that the degree of adhesion formation found at re-laparotomy could be reduced with the use of an adhesion barrier at the previous hepatectomy. 8 However, the efficacy of other types of adhesion barriers introduced later has not yet been clarified, and the factors associated with the degree of adhesion formation found at a future repeat hepatectomy are not yet fully understood. Therefore, in this study, we sought to examine the efficacy of various types of adhesion barriers and investigate the risk factors associated with severe adhesion formation at repeat hepatectomy.…”