P.O.P.A. Study: Prevention of Postoperative Abdominal Adhesions by Icodextrin 4% Solution After Laparotomy for Adhesive Small Bowel Obstruction. A Prospective Randomized Controlled Trial

Catena, Fausto; Ansaloni, Luca; Saverio, Salomone Di; Pinna, Antonio

doi:10.1007/s11605-011-1736-y

Cited by 81 publications

(45 citation statements)

References 20 publications

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“…New products or postoperative management procedures for reducing adhesions have been reported in abdominal surgery [31][32][33][34][35][36][37] . However, almost all reports assessed the reduction of adhesions in open surgery, with only one report referring to laparoscopic surgery 28) .…”

Section: Discussionmentioning

confidence: 99%

Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery

Fujii

Tsukamoto

Shimada

et al. 2018

J Anus Rectum Colon

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Abstract:Objectives: The protective efficacy of an absorptive adhesion prevention product (Seprafilm ) against bowel obstruction (BO) during open surgery was demonstrated in a large-scale randomized controlled clinical trial in Europe and America. However, the efficacy of Seprafilm against BO in laparoscopic surgery remains uncertain. The objective of this study was to clarify the protective efficacy of Seprafilm against BO after laparoscopic surgery for colorectal cancer. Methods: From 2009 to 2016, 1328 laparoscopic colorectal resections were performed for colorectal cancer. From 2009, Seprafilm was used for preventing BO in laparoscopic colorectal surgery. The incidence of BO and short-term results were compared between the Seprafilm and non-Seprafilm groups after propensity score matching. Results: Propensity scoring generated 270 matched patients per group for the comparisons between the Seprafilm and non-Seprafilm groups. The two groups showed no significant differences regarding patients' backgrounds. Among all patients, 73.1% (19/26) of BO occurred within 30 days after the surgery. Significantly lower incidences of all grade (2.6% vs. 7.0%; p = 0.016) and grade 2 + 3a (1.5% vs. 5.2%; p = 0.017) BO were observed in the Seprafilm group than in the non-Seprafilm group; no significant difference regarding grade 3b BO (1.1% vs. 1.9%; p = 0.476) was found. A significant difference in BO within 30 days was also noted between the two groups (1.9% vs. 5.2%, p = 0.036). There were no significant differences between the groups regarding anastomotic leakage and deep surgical site infection. Conclusions: Seprafilm was useful for preventing BO, requiring decompression therapy of the bowel, after laparoscopic colorectal surgery without increasing adverse events.

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Section: Discussionmentioning

confidence: 99%

Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery

Fujii

Tsukamoto

Shimada

et al. 2018

J Anus Rectum Colon

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“…Some studies show that 4% Icodextrin reduces the incidence of primary IAs and their reformation by separating the damaged area during the sensitive phase of recovery (15,22,23 Icodextrin for the prevention of IAs. The authors concluded that the application of 4% Icodextrin to extensively de-serosalized surfaces was more convenient when compared to other antiadhesive barriers (22)(23)(24). In contrast to the above findings, Ditzel et al (25) showed that 4% Icodextrin was not effective in significantly reducing the formation of adhesions.…”

Section: Resultsmentioning

confidence: 99%

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin

Urkan¹,

Özerhan²,

Ünlü³

et al. 2016

Balkan Med J

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Background:Intraabdominal adhesions remain a significant cause of morbidity and mortality. Moreover, intraabdominal adhesions can develop in more than 50% of abdominal operations. Aims: We compared the anti-adhesive effects of two different agents on postoperative adhesion formation in a cecal abrasion model. Study Design: Experimental animal study. Methods: Forty Wistar albino type female rats were anesthetized and underwent laparotomy. Study groups comprised Sham, Control, Mitomycin-C, 4% Icodextrin, and Mitomycin-C +4% Icodextrin groups. Macroscopic and histopathological evaluations of adhesions were performed. Results: The frequencies of moderate and severe adhesions were significantly higher in the control group than the other groups. The mitomycin-C and Mitomycin-C +4% Icodextrin groups were associated with significantly lower adhesion scores compared to the control group and 4% Icodextrin group scores (p=0.002 and p=0.008, respectively). The adhesion scores of the Mitomycin-C group were also significantly lower than those of the 4% Icodextrin group (p=0.008). Conclusion: Despite its potential for bone marrow toxicity, Mitomycin-C seems to effectively prevent adhesions. Further studies that prove an acceptable safety profile relating to this promising anti-adhesive agent are required before moving into clinical trials.

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“…However, few human studies focusing on the efficacy of icodextrin on adhesion prevention have been published to date [9][10][11][12]16]. There have been even fewer studies evaluating the clinical benefits of icodextrin after general surgery, the results of which seem to be somewhat conflicting [17,18]. Thus, the overall clinical advantages of icodextrin, especially the long-term clinical results, are still questionable and further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results

et al. 2016

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Icodextrin (Adept®) has been shown to prevent postoperative adhesions in experimental and laparoscopic adhesiolysis surgery. However, the role of icodextrin in the prevention of adhesions in extensive gynecological surgery is unclear. The present study evaluated the effect of icodextrin on adhesion-related readmissions after extensive gynecological surgery. The hospital readmissions of 140 endometriosis patients operated on at Päijät-Häme Central Hospital in 2004-2008 with the use of icodextrin were retrospectively reviewed. The evaluation of readmissions focused on adhesion-related disorders and reoperations. If an abdominal or pelvic reoperation was performed, the extent of the adhesions was classified. The mean follow-up time was 6.53 years (range 0.21-9.83). After initial surgery, one patient (0.7 %) had adhesive small bowel obstruction. Another directly adhesion-related readmission occurred in two patients (1.4 %). The number of readmissions possibly related to adhesions was 3 (2.1 %). Abdominal or pelvic reoperation was performed on 54 patients (38.6 %): 4 in the open surgery group and 50 in the laparoscopic surgery group. The extent of the adhesions among the 54 reoperated patients was as follows: not mentioned in 16 patients, no adhesions in 14, mild in 18, moderate in 5, and severe in 1. There were two (3.7 %) bowel injuries (one enterotomy and one serosal lesion) in reoperations. The incidence of adhesion-related readmissions after the use of icodextrin is relatively low. This favorable result may be partly related to the laparoscopic technique. Despite the use of an anti-adhesion agent, in some patients, the extent of postoperative adhesions is severe.

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P.O.P.A. Study: Prevention of Postoperative Abdominal Adhesions by Icodextrin 4% Solution After Laparotomy for Adhesive Small Bowel Obstruction. A Prospective Randomized Controlled Trial

Abstract: The data resulting from this RCT showed that the use of icodextrin 4% solution in ASBO is safe and reduces intra-abdominal adhesion formation and the risk of re-obstruction.

Cited by 81 publications

References 20 publications

Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery

Absorptive anti-adhesion barrier for the prevention of bowel obstruction after laparoscopic colorectal cancer surgery

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin

Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results

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