Pilot study evaluating the efficacy of AlloMEM™ for prevention of intraperitoneal adhesions and peritoneal regeneration after loop ileostomy

Effects of anchoring sutures at diverting ileostomy after rectal cancer surgery on peritoneal adhesion at following ileostomy reversal

Purpose

During diverting ileostomy reversal for rectal cancer patients who underwent previous sphincter-saving surgery, the extent of adhesion formation around the ileostomy site affects operative and postoperative outcomes. Anchoring sutures placed at the time of the ileostomy procedure may reduce adhesions around the ileostomy. This study aimed to evaluate the effects of anchoring sutures on the degree of adhesion formation and the postoperative course at the time of ileostomy reversal.

Methods

Patients who underwent sphincter-saving surgery with diverting ileostomy for rectal cancer between January 2013 and December 2017 were enrolled. Variables including the peritoneal dhesion index (PAI) score, operation time, the length of resected small bowel, operative complications, and postoperative hospital stay were collected prospectively and compared between the anchoring group (AG) and non-anchoring group (NAG).

Results

A total of 90 patients were included in this study, with 60 and 30 patients in the AG and NAG, respectively. The AG had shorter mean operation time (46.88 ± 16.37 minutes vs. 61.53 ± 19.36 minutes, P = 0.001) and lower mean PAI score (3.02 ± 2.53 vs. 5.80 ± 2.60, P = 0.001), compared with the NAG. There was no significant difference in the incidence of postoperative complications between the AG and NAG (5.0% vs. 13.3%, respectively; P = 0.240).

Conclusion

Anchoring sutures at the formation of a diverting ileostomy could decrease the adhesion score and operation time at ileostomy reversal, thus may be effective in improving perioperative outcomes.

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

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.