MICROSURGERY ALONE OR WITH INTERCEED ABSORBABLE ADHESION BARRIER FOR PELVIC SIDEWALL ADHESION RE-FORMATION

Adhesion re-formation after a reproductive operation, particularly inv olving the pelvic sidewall, is a prominent cause of failure in the sur gical treatment of infertility. This study was done to evaluate the im pact of standard microsurgery through laparotomy and the additional be nefit of an oxidized regenerated cellulose adhesion barrier (INTERCEED (R) TC7! Absorbable Adhesion Barrier Ethicon Inc.!), in reducing pel vic sidewall adhesion re-formation. One hundred and thirty-four patien ts with bilateral pelvic sidewall adhesions undergoing adhesiolysis by standard microsurgical techniques through laparotomy were treated dur ing a prospective randomized trial involving 13 centers. After adhesio lysis, the deperitonealized surface of one pelvic sidewall was randoml y assigned to be covered with INTERCEED Barrier, the contralateral sid ewall serving as control. A second-look laparoscopy was performed ten days to 14 weeks postoperatively. Microsurgical adhesiolysis alone res ulted in 24 percent of the sidewalls becoming free of adhesions and a 55.6 percent reduction in the area of adherent peritoneum. With micros urgery alone, 60 and 39 percent of adhesions initially characterized a s filmy or severe, respectively, were not seen at second-look laparosc opy. The use of INTERCEED Barrier increased the incidence of adhesion- free sidewalls twofold. The treatment was also associated with a stati stically significant reduction in the area of peritoneum affected by a dhesion re-formation, compared with the control wall. Of the adhesions originally graded as severe, 61 percent of those treated with INTERCE ED Barrier did not re-form at all. When evaluated on filmy adhesions, the use of the barrier was associated with a 72 percent reduction in a dhesion re-formation. A measurable reduction in adhesion re-formation was found, depending on the initial adhesion type, with microsurgery a lone. The addition of INTERCEED Barrier further reduced the incidence, extent and severity of postoperative adhesion re-formation. In this s tudy, 90 percent of die patients benefited from the use of INTERCEED B arrier.