A NOVEL TECHNIQUE FOR THE LAPAROSCOPIC APPLICATION OF THE SEPRAFILM® ADHESION BARRIER

A. Advincula, A. Song, W. Burke, R.K. Reynolds

University of Michigan, Ann Arbor, MI

OBJECTIVE:  We sought to develop a technique for the introduction of the Seprafilm® Adhesion Barrier into the abdominopelvic cavity during laparoscopic surgery.
MATERIALS AND METHODS:   Postoperative adhesions occur in 60% to 90% of patients undergoing major gynecologic surgery. Although laparoscopy has been shown to decrease the development of adhesions when compared to laparotomy, adhesions still occur. They can often result in infertility, chronic pelvic pain, intestinal obstruction, and/or difficult re-operative surgery. All commercially available adhesion barriers are not designed to be easily applied during laparoscopic surgery.

The Seprafilm® Adhesion Barrier is a sterile, bioresorbable translucent membrane composed of two anionic polysaccharides, sodium hyaluronate (HA) and carboxymethylcellulose (CMC). It serves as a temporary bioresorbable barrier separating apposing tissue surfaces. When applied within the abdominopelvic cavity, it can be expected to reduce adhesions during the early phases of peritoneal wound repair. A noteworthy property is that approximately 24 to 48 hours after placement, the membrane becomes a hydrated gel that is slowly resorbed within one week. Excretion from the body occurs within 28 days.

By taking advantage of the membranes conversion to a hydrated gel within the body, a novel technique for introducing this adhesion barrier into the abdominopelvic cavity during laparoscopy was developed. A single multi-pack of the Seprafilm® Adhesion Barrier containing six – 3 x 5 inch membranes was determined by our gynecology service to adequately cover the pelvic peritoneum during gynecologic surgery. Each membrane is cut into shavings with Metzenbaum scissors and a gelatinous mixture is formed by combining it with 35 milliliters of saline in a basin. This process is performed approximately 30 minutes prior to application and loaded into a 60 milliliter Toumy catheter tip syringe. A size 20 Red Robinson catheter is used to introduce the gelatinous mixture into the pelvis through either the fascial defect created by a 5 millimeter trocar or through a 10 millimeter trocar. The inverted inner electrode of a reusable Kleppinger bipolar forceps can be used as a guidewire through the catheter during placement through a fascial defect or trocar. After evacuating all irrigation, an assistant can help guide the Red Robinson catheter tip with atraumatic graspers during injection of the slurry. The consistency of the gelatinous mixture is one that allows it to adhere to the peritoneal surfaces of the pelvis and reproductive viscera.  

RESULTS:  We have used this technique of applying the Seprafilm® Adhesion Barrier in a variety of gynecologic procedures where concern for adhesion prevention exists. These laparoscopic procedures are myomectomy, extensive resection of endometriosis or lysis of adhesions, supracervical hysterectomy, and certain oncologic staging cases.
CONCLUSION:  The conversion of the Seprafilm® Adhesion Barrier from a membrane into a gelatinous mixture allows for its easy application in laparoscopic surgery.

Key Words:   surgical technique, adhesions, laparotomy, laparoscopy

Disclosure – Nothing to disclose.