Adhesions and Colorectal Surgery | SEPRAFILM

SEPRAFILM® and Colorectal Surgery

Adhesions are a common consequence of open surgery, forming in 93% of patients who undergo abdominal laparotomy.¹ Adhesions account for up to:

75% of small bowel obstructions²
40% of infertility cases³
48% of chronic pelvic pain cases⁴

Adhesions to prior incisions and surgical sites may also increase the complexity of future surgeries. In the worst cases, multiple, dense adhesions can completely obscure access to the abdominal cavity, often referred to as “concrete abdomen.”

"Concrete abdomen" - cohesive adhesions between loops of small bowel

The effects of adhesions on subsequent surgery include:

Increased procedure and re-entry time⁵
Difficulty differentiating and accessing tissue planes⁶
Increased risk of inadvertent enterotomy⁷
Potential reoperation for small bowel obstruction⁸

Adhesions can also limit and complicate future treatment options, including laparoscopy⁶, radiotherapy⁹, and intraperitoneal chemotherapy.⁶

SEPRAFILM Adhesion Barrier is proven to help prevent postoperative adhesions.¹⁰

Incidence of reoperative intestinal obstruction

No adhesion barrier has been evaluated more extensively in abdominopelvic surgery.¹² SEPRAFILM is proven safe in the presence of an anastomosis and is proven to provide clinical benefit at bowel resection, ostomy creation, and radical pelvic surgery when used as directed (see important safety information below). In a series of prospective clinical trials, SEPRAFILM placement at a primary procedure was shown to significantly reduce reoperative complexity, including inadvertent injury and operative time.¹¹^,¹³ In a large randomized, controlled trial of patients receiving SEPRAFILM at intestinal resection, SEPRAFILM reduced the incidence of reoperative adhesive small bowel obstruction (SBO) by 47%.⁸

Open procedures in which SEPRAFILM can be applied include¹⁰:

Surgery for inflammatory bowel disease
Radical abdominopelvic surgery
Exploratory laparotomy
Ileostomy creation and closure
Hartmann’s procedure
Small bowel resection
Right hemicolectomy
Left hemicolectomy
Sigmoid colectomy
Ileal pouch creation
Low anterior resection
Abdominoperitoneal resection
Bariatric surgery
Hepatobiliary and pancreatic surgery
Gastric resection
Liver resection
Hernia repair

1. Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl. 1990;72:60-63.

2. Scovill WA. Small bowel obstruction. In: Cameron JL, ed. Current Therapy in Surgery. St Louis, MO: Mosby Yearbook Medical Publishers, Inc; 1995:100-104.

3. DiZerega GS. Peritoneal repair and postsurgical adhesion formation. In: Management of Common Problems in Obstetrics & Gynecology. Mishell DR, Goodwin Murphy T, Brenner PF, eds. Malden, MA: Blackwell Publishing; 2002: 267-271.

4. Stovall TG, Elder RF, Ling FW. Predictors of pelvic adhesions. J Reprod Med. 1989;34:345-348.

5. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet1999;353(9163):1476-1480.

6. Nichols DH, Clarke-Pearson DL, eds. Gynecologic, Obstetric, and Related Surgery. 2^nd ed. St. Louis, MO: Mosby, Inc; 1993.

7. Van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MMPJ, Schaapveld M, van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87(4):467-471.

8. Fazio VW, Cohen Z, Fleshman JW, et al. Reduction in adhesive small-bowel obstruction by Seprafilm Adhesion Barrier after intestinal resection. Dis Colon Rectum. 2005;49:1-11.

9. Eifel PF. Radiation therapy. In: Berek JS, Hacker NF, eds. Practical Gynecologic Oncology, 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: 119-161.

10. SEPRAFILM Prescribing Information. Cambridge, MA: Genzyme Biosurgery; 2007

11. Tang C-L, Seow-Choen F, Fook-Chong S, Eu K-W. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision. Dis Colon Rectum. 2003;46:1200-1207.

12. Data on File, Genzyme Corporation

13. Kusunoki M, Ikeuchi H, Yanagi H, et al. Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial. Surg Today. 2005;35:940-945.