- Surgical Barriers – Effective at Preventing Adhesion Pain?
Surgeons have a number of products at their disposal for reducing the risk of adhesions, including synthetic barrier agents. It is their responsibility to make patients aware of the potential benefits and risks of using these products before a procedure takes place.
Synthetic barrier products may reduce adhesion risk by replicating the naturally occurring membranes that cover your vital organs. When the delicate surfaces of your organs make contact with each other during surgery – especially abdominal and pelvic surgeries — the tissues may adhere to each other.
Surgical trauma often leads to the formation of scar tissue, which can eventually cause the intestines to twist, pull, kink or become blocked. A partial intestinal blockage may be resolved under close medical supervision. A complete blockage is a medical emergency, often requiring immediate surgery. Adhesions after abdominal or pelvic surgery may also cause infertility in women. Severe abdominal pain, nausea, loud bowel sounds and bloating are common symptoms of adhesions.
- How Surgical Barriers Work
In combination with safe operative technique, surgical barriers may reduce the risk of scar formation and adhesion pain. During abdominal or pelvic surgery, synthetic barrier sheets made of regenerated cellulose, polytetrafluoroethylene or Fibrin may be applied to abdominal or pelvic tissues to keep organ surfaces separate. While some commonly used products, such as Gore-Tex, must be sutured into place and removed during a separate procedure, Interceed and Seprafilm, both Johnson & Johnson products, are absorbed into the body after surgery. Note* Insurance companies often do not compensate for the use of barrier products, transferring the financial responsibility onto the patient.
A 2008 review published in the Cochrane Database of Systematic Reviews compared the results of 16 clinical trials to evaluate the effectiveness of four barrier products at preventing adhesions in women undergoing pelvic surgery. The reviewers evaluated the results of using Gore-Tex, Interceed, Seprafilm and Fibrin. In the majority of the trials, Gore-Tex was more effective than Interceed or no barrier at preventing adhesions after surgery. Further clinical studies have shown that Interceed and Seprafilm may reduce the risk of pelvic and abdominal adhesions if they are used correctly.
The SprayShield Adhesion Barrier System, currently available only in Europe, protects internal tissues through the application of a hydrogel spray. The hydrogel barrier, which turns blue upon application so that surgeons can visualize the covered areas, keeps organ surfaces separate both during and after surgery, while the tissues heal. After the necessary healing time, the material is absorbed by the body and excreted by the kidneys in the urine. Although the SprayShield barrier system has performed well in pre-clinical studies in the United States and has been available to patients in Europe since 2008, the product has not yet been approved by the Food and Drug Administration for use in the U.S.
- Risks of Using Surgical Barriers
Like sutures, gauze, sponges or any other material used during a surgical procedure, barrier agents may cause inflammation and adhesions if used incorrectly. If a barrier is wadded, folded or applied in layers, the material may induce adhesions. Barriers should not be applied to tissues that are infected or areas that have been contaminated. Because each body reacts differently to foreign materials, reactions to these synthetic membranes may occur. The removal of a non-absorbable barrier after surgery may pose a risk of further adhesion formation.
- Who Is Responsible for Preventing Adhesion Pain?
Synthetic barrier agents are not foolproof measures for preventing adhesions, but when correctly used, these products may reduce the risk of an often agonizing, potentially life-threatening condition known as adhesion related disorder (ARD). Medical professionals are responsible for using these products consistently, for educating patients about how adhesions are formed and for informing patients of the risk of adhesions before surgery.
On their product websites, Ethicon, the Johnson & Johnson company that manufactures the absorbable barrier Interceed, and Seprafilm advise patients to question their surgeon before surgery about the risk of adhesion formation and the signs and symptoms of adhesions after surgery. In reality, how many patients are likely to visit these websites before surgery? Is it realistic to expect patients to conduct research on barrier agents or other highly specialized surgical products?
In fact, the responsibility for bringing up the risk of adhesions — and for considering ARD as a reasonable explanation for post-surgical adhesion pain — belongs to surgeons and other healthcare professionals, not to patients. It is their duty, and part of their ethical commitment, to promote an awareness of adhesion risk and to listen carefully to their patients’ concerns before and after surgical intervention.
Sources
The Cochrane Library: Intervention Review: Barrier Agents for Adhesion Prevention after Gynaecological Surgery; Gaity Ahmad, et al.; April 16, 2008. “Journal of Reproductive Medicine”: Postoperative Adhesion Prevention with an Oxidized Regenerated Cellulose Adhesion Barrier in Infertile Women. T. Sawada, et al.; May 2000.
Pelvic Health Solutions: Overview: Gynecare Interceed.
Reuters.com: Covidien Introduces the SprayShield™ Adhesion Barrier System to the European Marketplace.